Trends in healthcare utilization among older Americans with colorectal cancer: A retrospective database analysis
Trends in healthcare utilization among older Americans with colorectal cancer: A retrospective database analysis
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DOI：
10.1186/1472-6963-9-227
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发表时间：
2009-12-10
影响因子：
2.8
通讯作者：
Menzin, Joseph
中科院分区：
文献类型：
--
作者：
Lang, Kathleen;Lines, Lisa M.;Menzin, Joseph
背景资料：利用趋势分析（成本驱动因素）使我们能够了解结直肠癌（CRC）成本随时间的变化，更好地预测未来成本，确定特定类型护理（如临终关怀）的使用变化，并为成本效益模型提供输入。这项回顾性队列研究评估了1992年至2002年期间诊断为CRC的美国医疗保险受益人的医疗资源使用情况。队列包括66岁以上新诊断为结肠腺癌的患者（n = 52，371）或直肠（n = 18，619），并与来自一般医疗保险人群的患者匹配，随访至死亡或2005年12月31日。按癌症亚部位评估人口统计学和临床特征。按阶段和子中心评价资源使用情况，包括使用每种资源的百分比、住院人数、住院天数和专业护理机构天数。计算每个队列每人每年的门诊、门诊和住院就诊次数，并按服务年份、子中心和治疗阶段进行描述。临终关怀的使用率在生命的最后一年计算的服务，阶段，和子网站的CRC患者死亡的CRC.Results：CRC患者（平均年龄：77.3岁，44.9%男性）使用更多的资源比对照组在每一个类别（P <0.001），最大的差异出现在住院天数和家庭健康使用。随着时间的推移，大多数资源的使用（临终关怀除外）保持相对稳定。在最初阶段，办公室和门诊就诊的资源最为紧张。临终关怀的使用CRC死亡的患者从1992年的20.0%增加到2004年的70.5%，与年龄相关的差异似乎已经在以后的岁月里evened out.Conclusion：在研究期间，使用临终关怀的CRC死者大幅增加，而其他资源的使用基本保持稳定。我们的研究结果可能有助于了解CRC成本驱动因素，跟踪趋势，并预测CRC患者未来的资源需求。
Background: Analyses of utilization trends (cost drivers) allow us to understand changes in colorectal cancer (CRC) costs over time, better predict future costs, identify changes in the use of specific types of care (eg, hospice), and provide inputs for cost-effectiveness models. This retrospective cohort study evaluated healthcare resource use among US Medicare beneficiaries diagnosed with CRC between 1992 and 2002.Methods: Cohorts included patients aged 66+newly diagnosed with adenocarcinoma of the colon (n = 52,371) or rectum (n = 18,619) between 1992 and 2002 and matched patients from the general Medicare population, followed until death or December 31, 2005. Demographic and clinical characteristics were evaluated by cancer subsite. Resource use, including the percentage that used each type of resource, number of hospitalizations, and number of hospital and skilled nursing facility days, was evaluated by stage and subsite. The number of office, outpatient, and inpatient visits per person-year was calculated for each cohort, and was described by year of service, subsite, and treatment phase. Hospice use rates in the last year of life were calculated by year of service, stage, and subsite for CRC patients who died of CRC.Results: CRC patients (mean age: 77.3 years; 44.9% male) used more resources than controls in every category (P < .001), with the largest differences seen in hospital days and home health use. Most resource use (except hospice) remained relatively steady over time. The initial phase was the most resource intense in terms of office and outpatient visits. Hospice use among patients who died of CRC increased from 20.0% in 1992 to 70.5% in 2004, and age-related differences appear to have evened out in later years.Conclusion: Use of hospice care among CRC decedents increased substantially over the study period, while other resource use remained generally steady. Our findings may be useful for understanding CRC cost drivers, tracking trends, and forecasting resource needs for CRC patients in the future.