Assessment and prediction of costs and adverse health outcomes in COPD

描述（由申请人提供）：慢性阻塞性肺疾病（COPD）是美国死亡和残疾的主要原因，给已经承受巨大压力的医疗保健系统增加了巨大的经济负担。为了有效地分配我们有限的资源，最大限度地提高我国人口的整体健康水平，我们必须深刻理解这种疾病的总成本负担，不仅包括直接成本，还包括工作生产力损失等间接成本。此外，拥有经过良好测试的模型来预测成本和不良健康结果对于针对疾病管理计划以及在研究背景下，当研究人员试图了解新的暴露或干预措施的影响时非常重要。此外，在资本支付机制中，对可能的成本进行风险调整至关重要，以阻止提供者和保险公司避免高成本患者，并对医生进行风险调整成本效益评估。糟糕的风险调整方法可能会让病情更重的患者缺乏医生和保险覆盖范围。拟议的研究将增加额外的分析和数据收集的母研究，已收集基线调查和诊断测试信息的队列1202 COPD受试者和302对照Kaiser Permanente，一个大型的综合卫生系统。拟议的研究将首先在基线评估后评估这些受试者的直接和间接成本。我们将利用凯泽的成本管理信息系统来确定直接成本。间接成本将通过后续电话调查进行评估，使用与申请人的研究导师在检查哮喘间接成本时所采用的技术类似的技术。我们的第二个目标将是开发成本和作为次要结果的不良健康结果的预测模型。这些模型将利用风险调整中使用的传统测量方法，如社会人口统计学和合并症数据，然后测试多方面方法测量COPD严重程度的额外预测价值。 相关性：COPD是美国死亡和残疾的主要原因，并给已经承受相当大压力的医疗保健系统增加了巨大的经济负担。了解COPD成本的驱动因素，包括机构和个人承担的成本，对于我们将资源用于最需要的地方至关重要。此外，制定一个透明的程序，让医疗保健支付者（如政府）预测哪些患者可能是最昂贵的，这将使我们能够调整对医疗保险公司的支付，以阻止他们避开病情最严重的患者。

DESCRIPTION (provided by the applicant): Chronic obstructive pulmonary disease (COPD) is a leading cause of death and disability in the United States and adds substantial economic burden to a health care system that is already under significant strain. To efficiently allocate our limited resources to maximize the overall health of our population, we must have a strong understanding of the total cost burden of this disease, including not only direct costs but also indirect costs such as lost work productivity. Moreover, having well-tested models which predict costs and adverse health outcomes is important in targeting disease management programs and, within a research context, when investigators are trying to understand the impact of a new exposure or intervention. Furthermore, risk adjustment for likely costs is critical in capitated payment mechanisms to discourage providers and insurers from avoiding high-cost patients and in risk-adjusting cost-efficiency evaluations of physicians. Poor risk adjustment methods may leave sicker patients with a dearth of physician and insurance-coverage options. The proposed study would add additional analyses and data collection to a parent study which has collected baseline survey and diagnostic testing information on a cohort of 1202 COPD subjects and 302 controls within Kaiser Permanente, a large integrated health system. The proposed study will first provide an assessment of both the direct and indirect costs for these subjects subsequent to their baseline assessment. We will utilize Kaiser's Cost Management Information System to determine direct costs. Indirect costs will be assessed with follow-up telephone surveys, using techniques similar to those employed by the applicant's research mentors in their examination of the indirect costs of asthma. Our second aim will then be to develop prediction-models for both costs and, as a secondary outcome, adverse health outcomes. These models will utilize both traditional measures used within risk-adjustment, such as sociodemographics and comorbidity data, and then test the additional predictive value of a multifaceted approach to measuring COPD severity. RELEVANCE: COPD is a leading cause of death and disability in the United States and adds substantial economic burden to a health care system which is already under considerable strain. Understanding the factors that drive costs in COPD, both costs borne by the institutions and by individuals, is critical to our ability to utilize our resources where they are needed most. Moreover, developing a transparent process to allow health care payers, such as the government, to predict which patients are likely to be the most costly will allow us to adjust payments to health insurers to discourage them from avoiding the sickest patients.