Multimorbidity and healthcare utilisation among high-cost patients in the US Veterans Affairs Health Care System.
Multimorbidity and healthcare utilisation among high-cost patients in the US Veterans Affairs Health Care System.
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DOI：
10.1136/bmjopen-2015-007771
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发表时间：
2015-04-16
期刊：
影响因子：
2.9
通讯作者：
Asch SM
中科院分区：
文献类型：
--
作者：
Zulman DM;Pal Chee C;Wagner TH;Yoon J;Cohen DM;Holmes TH;Ritchie C;Asch SM
To investigate the relationship between multimorbidity and healthcare utilisation patterns among the highest cost patients in a large, integrated healthcare system. In this retrospective cross-sectional study of all patients in the U.S. Veterans Affairs (VA) Health Care System, we aggregated costs of individuals’ outpatient and inpatient care, pharmacy services and VA-sponsored contract care received in 2010. We assessed chronic condition prevalence, multimorbidity as measured by comorbidity count, and multisystem multimorbidity (number of body systems affected by chronic conditions) among the 5% highest cost patients. Using multivariate regression, we examined the association between multimorbidity and healthcare utilisation and costs, adjusting for age, sex, race/ethnicity, marital status, homelessness and health insurance status. USA VA Health Care System. 5.2 million VA patients. Annual total costs; absolute and share of costs generated through outpatient, inpatient, pharmacy and VA-sponsored contract care; number of visits to primary, specialty and mental healthcare; number of emergency department visits and hospitalisations. The 5% highest cost patients (n=261 699) accounted for 47% of total VA costs. Approximately two-thirds of these patients had chronic conditions affecting ≥3 body systems. Patients with cancer and schizophrenia were less likely to have documented comorbid conditions than other high-cost patients. Multimorbidity was generally associated with greater outpatient and inpatient utilisation. However, increased multisystem multimorbidity was associated with a higher outpatient share of total costs (1.6 percentage points per affected body system, p<0.01) but a lower inpatient share of total costs (−0.6 percentage points per affected body system, p<0.01). Multisystem multimorbidity is common among high-cost VA patients. While some patients might benefit from disease-specific programmes, for most patients with multimorbidity there is a need for interventions that coordinate and maximise efficiency of outpatient services across multiple conditions.
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影响因子：
39.2
作者：
Asch, SM;McGlynn, EA;Kerr, EA
通讯作者：
Kerr, EA
DOI：
10.1111/j.1532-5415.1999.tb04580.x
发表时间：
1999-02-01
影响因子：
6.3
作者：
Newcomer, R;Clay, T;Miller, RH
通讯作者：
Miller, RH
影响因子：
2.5
作者：
Phibbs, CS;Bhandari, A;Barnett, PG
通讯作者：
Barnett, PG
DOI：
10.1016/j.hjdsi.2013.07.008
发表时间：
2013-12-01
影响因子：
2.5
作者：
Grant, Richard W.;Adams, Alyce S.;Heisler, Michele
通讯作者：
Heisler, Michele
DOI：
10.1111/j.1532-5415.2012.04158.x
发表时间：
2012-10-01
影响因子：
6.3
作者：
Steinman, Michael A.;Lee, Sei J.;Schwartz, Janice B.
通讯作者：
Schwartz, Janice B.