Patterns of health care utilization and cost before and after opioid overdose: findings from 10-year longitudinal health plan claims data
Patterns of health care utilization and cost before and after opioid overdose: findings from 10-year longitudinal health plan claims data
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DOI：
10.2147/sar.s135884
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发表时间：
2017-01-01
影响因子：
1.8
通讯作者：
Boscarino, Joseph A.
中科院分区：
文献类型：
--
作者：
Maeng, Daniel D.;Han, John J.;Boscarino, Joseph A.
目的：描述纵向模式的医疗保健利用率和成本的护理之前和之后阿片类药物过量（OD）超过10年的时间使用健康计划索赔data.Methods：患者谁经历了阿片类药物过量2005年4月至2015年3月之间，确定从盖辛格卫生系统的电子健康记录。在这些患者中，还确定了2006年1月至2015年12月期间任何时间点为Geisinger健康计划（GHP）成员的患者亚组。从相应的GHP索赔数据中，获得了他们的全因医疗保健利用（住院、急诊[艾德]就诊和医生办公室就诊）和总医疗费用（不包括处方药费用）。每个成员每月估计每个月之前和之后的阿片类药物OD的索引日期进行计算，调整年龄，性别，计划类型，年，并通过多变量回归models.Results：共942阿片类药物OD患者的平均GHP入组期为41.4个月。从阿片类药物OD日期前约19-24个月开始，艾德访视率迅速上升。急性住院率和总医疗费用也从大约12个月前开始迅速上升。OD日期后，利用率和成本下降，但往往保持高于前OD period.Conclusion：阿片类药物OD之前的急性护理和成本的利用率急剧上升，以及在实际OD。因此，这些研究结果表明，OD的早期信号可以从急性护理利用模式中检测到，特别是艾德访视。
Objective: To describe the longitudinal pattern of health care utilization and cost of care before and after opioid overdose (OD) over a 10-year period using health plan claims data.Methods: Patients who had experienced opioid ODs between April 2005 and March 2015 were identified from Geisinger Health System's electronic health records. Among these patients, a subgroup of patients who were Geisinger Health Plan (GHP) members at any point between January 2006 and December 2015 were also identified. From the corresponding GHP claims data, their all-cause health care utilization (inpatient admissions, emergency department [ED] visits, and physician office visits) and total medical costs, excluding prescription medication cost, were obtained. Per-member-per-month estimates for each month before and after the index date of opioid OD were calculated, adjusting for age, gender, plan type, year, and comorbidity via multivariate regression models.Results: A total of 942 opioid OD patients with an average GHP enrollment period of 41.4 months were identified. ED visit rates rose rapidly starting around 19-24 months prior to the opioid OD date. Acute inpatient admission rates and total medical cost also rose rapidly starting around 12 months prior. After the OD date, the utilization rates and cost declined but tended to remain above those of the pre-OD period.Conclusion: Opioid OD is preceded by sharp increases in utilization of acute care and cost well before the actual OD. These findings therefore suggest that early signals of OD may be detected from patterns of acute care utilization, particularly the ED visits.