Comorbidity and its relationship with health service use and cost in community-living older adults with diabetes: A population-based study in Ontario, Canada
Comorbidity and its relationship with health service use and cost in community-living older adults with diabetes: A population-based study in Ontario, Canada
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DOI：
10.1016/j.diabres.2016.10.009
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发表时间：
2016-12-01
影响因子：
5.1
通讯作者：
Ploeg, Jenny
中科院分区：
文献类型：
--
作者：
Fisher, Kathryn;Griffith, Lauren;Ploeg, Jenny
目的：这项研究描述了加拿大社区居住的老年糖尿病患者的共病情况，以及合并疾病的数量与医疗服务使用和费用之间的关系。方法：这项回溯性队列研究使用多个相关的管理数据来确定截至2008年4月1日(基线)，66岁及以上社区居住的糖尿病患者的5年医疗服务利用情况。利用包括医生就诊、急诊科就诊、住院和家庭护理服务。结果：基线时376,421名队列成员，几乎所有(95%)都有至少一种共病，一半(46%)有3种或更多。最常见的并发症是高血压(83%)和关节炎(61%)。随着所有服务和后续年份的合并症数量增加，服务使用和相关费用持续增加。通常被认为与糖尿病无关的疾病是服务使用的主要驱动因素。随着时间的推移，对于共病水平最高的人(3+)来说，大多数服务的使用率都有所下降。住院和急诊科就诊是共病程度最高(3+)的人的最大费用份额，而看医生是合并症较少的人的主要费用。结论：社区老年糖尿病患者的合并症很常见，并与较高的卫生服务使用率和费用有关。因此，重要的是使用多种慢性病(而不是单一疾病)框架为老年糖尿病患者制定协调、全面和以患者为中心的计划，以便将他们的所有需求纳入护理计划。(C)2016爱思唯尔爱尔兰有限公司。保留所有权利。
Aims: This study describes the comorbid conditions in Canadian, community-dwelling older adults with diabetes and the association between the number of comorbidities and health service use and costs.Methods: This retrospective cohort study used multiple linked administrative data to determine 5-year health service utilization in a population-based cohort of community-living individuals aged 66 and over with a diabetes diagnosis as of April 1, 2008 (baseline). Utilization included physician visits, emergency department visits, hospitalizations, and home care services.Results: There were 376,421 cohort members at baseline, almost all (95%) of which had at least one comorbidity and half (46%) had 3 or more. The most common comorbidities were hypertension (83%) and arthritis (61%). Service use and associated costs consistently increased as the number of comorbidities increased across all services and follow-up years. Conditions generally regarded as nondiabetes-related were the main driver of service use. Over time, use of most services declined for people with the highest level of comorbidity (3+). Hospitalizations and emergency department visits represented the largest share of costs for those with the highest level of comorbidity (3+), whereas physician visits were the main costs for those with fewer comorbidities.Conclusions: Comorbidities in community-living older adults with diabetes are common and associated with a high level of health service use and costs. Accordingly, it is important to use a multiple chronic conditions (not single-disease) framework to develop coordinated, comprehensive and patient-centred programs for older adults with diabetes so that all their needs are incorporated into care planning. (C) 2016 Elsevier Ireland Ltd. All rights reserved.