Annual Burden and Costs of Hospitalization for High-Need, High-Cost Patients With Chronic Gastrointestinal and Liver Diseases.
Annual Burden and Costs of Hospitalization for High-Need, High-Cost Patients With Chronic Gastrointestinal and Liver Diseases.
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DOI：
10.1016/j.cgh.2018.02.015
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发表时间：
2018-08
期刊：
影响因子：
--
通讯作者：
Singh S
中科院分区：
文献类型：
--
作者：
Nguyen NH;Khera R;Ohno-Machado L;Sandborn WJ;Singh S
我们估计了慢性胃肠道和肝脏疾病患者的年度负担和住院费用，并在全国代表性样本中确定了高需求，高费用患者的特征。使用2013年全国再入院数据库，我们确定了2013年1月至6月期间至少有1次住院的患者，并诊断为炎症性肠病（IBD）、慢性肝病（CLD）、功能性胃肠道疾病（FGID）、胃肠道出血或胰腺疾病，随访6个月或更长时间。我们计算了住院天数/月，估计了整个队列的费用，并确定了高需求、高费用患者的特征（住院天数/月的前十分位）。IBD（n= 47，402）、CLD（n= 376，810）、FGID（n= 351，583）、胃肠道出血（n= 190，881）或胰腺疾病（n= 98，432）患者至少住院一次，每年住院时间的中位数为6-7天（四分位数间距，3-14）（所有疾病的总和）。与最低十分位数的患者（住院时间中位数为0.13-0.14天/月）相比，最高十分位数的患者住院时间中位数为3.7-4.1天/月（所有疾病的总和），住院费用范围为7502美元/月至8925美元/月，每2个月住院1次。胃肠道疾病、感染和心肺原因是这些患者住院的主要原因。基于多因素Logistic回归分析，“高需求，高成本”的患者更有可能有医疗保险/医疗补助保险，低收入状况，在大型农村医院的指数住院，高合并症负担，肥胖和感染相关的住院。在对至少住院一次的IBD、CLD、FGID、胃肠道出血或胰腺疾病患者进行的全国性数据库分析中，我们发现一小部分高需求、高费用患者对住院费用的贡献不成比例。针对这些患者的人口健康管理将促进高价值护理。
We estimated annual burden and costs of hospitalization in patients with chronic gastrointestinal and liver diseases, and identified characteristics of high-need, high-cost patients, in a nationally representative sample. Using Nationwide Readmissions Database 2013, we identified patients with at least 1 hospitalization between January-June 2013, and a diagnosis of inflammatory bowel diseases (IBD), chronic liver diseases (CLDs), functional gastrointestinal disorders (FGIDs), gastrointestinal hemorrhage, or pancreatic diseases, with 6 months or more of follow up. We calculated days spent in hospital/month and estimated costs of entire cohort, and identified characteristics of high-need, high-cost patients (top decile of days spent in hospital/month). Patients with IBD (n=47,402), CLDs (n=376,810), FGIDs (n=351,583), gastrointestinal hemorrhage (n=190,881), or pancreatic diseases (n=98,432), hospitalized at least once, spent a median of 6–7 days (inter-quartile range, 3–14) in the hospital each year (total for all diseases). Compared to patients in the lowest decile (median 0.13–0.14 days/month spent in the hospital), patients in the highest decile spent a median 3.7–4.1 days/month in hospital (total for all diseases), with hospitalization costs ranging from $7502/month to $8925/month and 1 hospitalization every 2 months. Gastrointestinal diseases, infections, and cardiopulmonary causes were leading reasons for hospitalization of these patients. Based on multivariate logistic regression, ‘high-need, high-cost’ patients were more likely to have Medicare/Medicaid insurance, lower income status, index hospitalization in a large rural hospital, high comorbidity burden, obesity and infection-related hospitalization. In a nation-wide database analysis of patients with IBD, CLD, FGID, gastrointestinal hemorrhage or pancreatic diseases hospitalized at least once, we found that a small fraction of high-need, high-cost patients contribute disproportionately to hospitalization costs. Population health management directed towards these patients would facilitate high value care.
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DOI：
10.1093/intqhc/mzu071
发表时间：
2014-10
期刊：
International journal for quality in health care : journal of the International Society for Quality in Health Care
影响因子：
--
作者：
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