Characteristics of heart failure patients incurring high medical costs via matching specific health examination results and medical claim data: a cross-sectional study
Characteristics of heart failure patients incurring high medical costs via matching specific health examination results and medical claim data: a cross-sectional study
复制标题
DOI：
10.1136/bmjopen-2019-031422
复制
发表时间：
2019-12-01
期刊：
影响因子：
2.9
通讯作者：
Moriyama，Michiko
中科院分区：
文献类型：
--
作者：
Tamaki，Yuya;Kazawa，Kana;Moriyama，Michiko
目的通过匹配具体的年度体检结果和医疗理赔数据，描述高医疗费用患者的特征。明确检查项目与高医疗费用之间的关系，可以筛查高风险人群。设计一项横断面研究。受试者为广岛县广岛市2016年4月至2017年3月期间参加国民健康保险的人员。为了识别真正的心力衰竭（HF）患者，将医疗索赔数据中列出的疾病名称与心力衰竭处方药物进行比较，仅提取比较数据匹配的受试者。数据收集和分析具体健康检查包括关于生活习惯、人体测量、血压、血液检查和尿液检查等方面的调查问卷。使用帕累托分析描述了与心力衰竭受试者的医疗护理相关的总医疗费用的百分比。针对具体健康检查项目，我们对高费用组和低费用组进行了比较。检查每个变量的正态性和同方差性，并应用学生 t 检验和 χ2 检验。最后采用多元logistic回归分析检测健康检查项目中与高医疗费用相关的因素。结果Pareto分析显示，80%的医疗费用由30%的心力衰竭患者群体支付。心血管手术费用占手术总费用的54%，其中64%包含可预防疾病。肌酐（Cr）和γ-谷氨酰转肽酶（γ-GTP）水平以及吸烟史与高医疗费用相关。结论对心力衰竭患者的具体健康检查结果进行分析，发现高医疗费用、γ-GTP、Cr和吸烟之间存在关联。这些结果可以作为心力衰竭高危人群筛查的参考，有助于预防心力衰竭病情加重。
ObjectiveWe describe the characteristics of patients with high medical costs by matching specific annual medical examination results and medical claim data. Clarifying the relationships between examination items and high medical costs allows the screening of high-risk persons.DesignA cross-sectional study.SubjectsSubjects were persons insured by national health insurance in Hiroshima City, Hiroshima Prefecture, from April 2016 to March 2017. To identify true heart failure (HF) patients, the disease name listed in the medical claim data was compared with drugs prescribed for HF, with extraction of only subjects whose comparative data matched.Data collection and analysisThe specific health examination includes a questionnaire on areas such as lifestyle habits, anthropometry, blood pressure, blood tests and urine tests. The percentage of the total medical costs related to the medical care of subjects with HF was described using Pareto analysis. For specific health examination items, we compared the high-cost and low-cost groups. The normality and homoscedasticity of each variable was checked and Student’s t-tests and χ² tests were applied. Finally, multiple logistic regression analysis was used to detect factors in the health examination items related to high medical costs.ResultsPareto analysis showed that 80% of all medical costs were paid by 30% of the HF patient population. The fees for cardiovascular surgery accounted for 54% of the total surgical cost, 64% of which included preventable diseases. Levels of creatinine (Cr) and γ-glutamyl transpeptidase (γ-GTP) and a history of smoking were found to be related to high medical costs.ConclusionAnalysis of specific health examination results for HF patients revealed the association between high medical costs, γ-GTP, Cr, and smoking. These results can thus serve as a reference for screening persons at high risk of HF and help prevent the exacerbation of HF.