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Stewart AJ, Patten SB, Fiest KM, Williamson TS, Wick JP, Ronksley PE. Identifying Unique Subgroups of High-Cost Patients With Schizophrenia: A Population-Based Study Using Latent Class Analysis. Health Serv Insights 2023; 16:11786329231183317. [PMID: 37377884 PMCID: PMC10291413 DOI: 10.1177/11786329231183317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 06/03/2023] [Indexed: 06/29/2023] Open
Abstract
Schizophrenia does not present uniformly among patients and as a result this patient population is characterized by a diversity in the type and amount of healthcare supports needed for daily functioning. Despite this, little work has been completed to understand the heterogeneity that exists among these patients. In this work we used a data-driven approach to identify subgroups of high-cost patients with schizophrenia to identify potentially actionable interventions for the improvement of outcomes and to inform conversations on how to most efficiently allocate resources in an already strained system. Administrative health data was used to conduct a retrospective analysis of "high-cost" adult patients with schizophrenia residing in Alberta, Canada in 2017. Costs were derived from inpatient encounters, outpatient primary care and specialist encounters, emergency department encounters, and drug costs. Latent class analysis was used to group patients based on their unique clinical profiles. Latent class analysis of 1659 patients revealed the following patient groups: (1) young, high-needs males early in their disease course; (2) actively managed middle-aged patients; (3) elderly patients with multiple chronic conditions and polypharmacy; (4) unstably housed males with low treatment rates; (5) unstably housed females with high acute care use and low treatment rates. This taxonomy may be used to inform policy, including the identification of interventions most likely to improve care and reduce health spending for each subgroup.
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Affiliation(s)
- Andrew J Stewart
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, AB, Calgary, Canada
| | - Scott B Patten
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, AB, Calgary, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Kirsten M Fiest
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, AB, Calgary, Canada
| | - Tyler S Williamson
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, AB, Calgary, Canada
| | - James P Wick
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Paul E Ronksley
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, AB, Calgary, Canada
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Luo J, Collier W, Magno-Padron D, Tieman J, Pires G, Moss W, Rosales M, Kim J, Agarwal JP, Kwok AC. Characteristics of Nonelderly Adult Health Care Persistent Super Utilizers in Utah. Popul Health Manag 2022; 25:472-479. [PMID: 35353618 DOI: 10.1089/pop.2021.0275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
In the United States, the top 1% and top 5% of health care spenders account for 23% and 50% of total health care spending, respectively. These high spenders have been coined the term super utilizers (SU). The aim of this study was to identify the characteristics associated with these patients to aid in developing public health interventions aimed at transitioning patients out of the SU category and thus ultimately helping to control health care costs. The authors utilized the Utah All-Payer Claims Database and Utah Population Database from 2013 to 2015 to identify demographics, comorbid conditions, health care utilization, and cost characteristics of persistent super utilizers (PSU) (≥3 hospitalizations per year for 3 years) of health care compared with persistent nonsuper utilizers (PNSU) (<3 hospitalizations per year for 3 years). Multivariable logistic regression was utilized to identify the characteristics associated with PSU versus PNSU. Higher outpatient/Emergency Department/noninpatient (eg, visits with imaging and Centers for Medicare & Medicaid Services preventive visits) health care utilization and spending, and prevalence of comorbid disease and psychosocial conditions were associated with PSU. In multivariable analysis, factors such as heart disease, chronic kidney disease (CKD), diabetes, alcohol abuse, and depression were statistically significantly associated with higher odds of PSU, with the most noteworthy being CKD (odds ratio [OR] 6.85, 95% confidence interval [95% CI] 5.84-8.02; P < 0.001), alcohol abuse (OR 5.90, 95% CI 4.49-7.69; P < 0.001), and heart diseases (OR 4.41, 95% CI 3.74-5.18; P < 0.001). The annual health care cost of a PSU is about 11.5 times greater than a PNSU ($54,776 vs. $4801; P < 0.001).
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Affiliation(s)
- Jessica Luo
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Willem Collier
- Division of Biostatistics, Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - David Magno-Padron
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Joshua Tieman
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Giovanna Pires
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Whitney Moss
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Megan Rosales
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Jaewhan Kim
- Department of Physical Therapy and Athletic Training, and CTSI Health Economics Core, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Jayant P Agarwal
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Alvin C Kwok
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
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Bhatia D, Sutradhar R, Tinmouth J, Singh S, Lau C, Lipscombe LL. Influence of chronic comorbidities on periodic colorectal cancer screening participation: A population-based cohort study. Prev Med 2021; 147:106530. [PMID: 33771564 DOI: 10.1016/j.ypmed.2021.106530] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 01/18/2021] [Accepted: 03/21/2021] [Indexed: 02/07/2023]
Abstract
Guidelines recommend regular screening for colorectal cancer (CRC). We examined the effects of chronic comorbidities on periodic CRC testing. Using linked healthcare databases from Ontario, Canada, we assembled a population-based cohort of 50-74-year olds overdue for guideline-recommended CRC screening between April 1, 2004 and March 31, 2016. We implemented multivariable recurrent events models to determine the association between comorbidities and the rate of becoming up-to-date with periodic CRC tests. The cohort included 4,642,422 individuals. CRC testing rates were significantly lower in persons with renal disease on dialysis (hazard ratio, HR 0.66, 95% confidence interval, CI 0.63 to 0.68), heart failure (HR 0.75, CI 0.75 to 0.76), respiratory disease (HR 0.84, CI 0.83 to 0.84), cardiovascular disease (HR 0.85, CI 0.84 to 0.85), diabetes (HR 0.86, 95% CI 0.86 to 0.87) and mental illness (HR 0.88, CI 0.87 to 0.88). There was an inverse association between the number of medical conditions and the rate of CRC testing (5 vs. none: HR 0.30, CI 0.25 to 0.36; 4 vs. none: HR 0.48, CI 0.47 to 0.50; 3 vs. none: HR 0.59, CI 0.58 to 0.60; 2 vs. none: HR 0.72, CI 0.71 to 0.72; 1 vs. none: HR 0.85, CI 0.84 to 0.85). Having both medical and mental comorbidities was associated with lower testing rates than either type of comorbidity alone (HR 0.72, CI 0.71 to 0.72). In summary, chronic comorbidities present a barrier to periodic guideline-recommended CRC testing. Exploration of cancer prevention gaps in these populations is warranted.
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Affiliation(s)
- Dominika Bhatia
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College Street, M5T 3M6 Toronto, Ontario, Canada.
| | - Rinku Sutradhar
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College Street, M5T 3M6 Toronto, Ontario, Canada; ICES, 2075 Bayview Avenue, M4N 3M5 Toronto, Ontario, Canada
| | - Jill Tinmouth
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College Street, M5T 3M6 Toronto, Ontario, Canada; ICES, 2075 Bayview Avenue, M4N 3M5 Toronto, Ontario, Canada; Department of Medicine, University of Toronto, 1 King's College Circle, M5S 1A8 Toronto, Ontario, Canada; Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, M4N 3M5, Toronto, Ontario, Canada
| | - Simron Singh
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College Street, M5T 3M6 Toronto, Ontario, Canada; ICES, 2075 Bayview Avenue, M4N 3M5 Toronto, Ontario, Canada; Department of Medicine, University of Toronto, 1 King's College Circle, M5S 1A8 Toronto, Ontario, Canada; Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, M4N 3M5, Toronto, Ontario, Canada
| | - Cindy Lau
- ICES, 2075 Bayview Avenue, M4N 3M5 Toronto, Ontario, Canada
| | - Lorraine L Lipscombe
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College Street, M5T 3M6 Toronto, Ontario, Canada; ICES, 2075 Bayview Avenue, M4N 3M5 Toronto, Ontario, Canada; Department of Medicine, University of Toronto, 1 King's College Circle, M5S 1A8 Toronto, Ontario, Canada; Women's College Research Institute, Women's College Hospital, 76 Grenville Street, M5S 1B2 Toronto, Ontario, Canada
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DRG-Oriented Mathematical Calculation Model and Method of Integrated Medical Service Cost. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2020; 2020:3189676. [PMID: 33204299 PMCID: PMC7652627 DOI: 10.1155/2020/3189676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/28/2020] [Accepted: 09/28/2020] [Indexed: 11/17/2022]
Abstract
In the context of the new round of medical and health reform, in order to alleviate the problem of "difficult to see a doctor and expensive to see a doctor," the state focuses on reducing the cost of medical services, so it puts forward the calculation and method research of medical costs. The purpose of this study is to calculate and predict the cost of medical services in a DRG-oriented integrated environment. In this study, activity-based costing and weighted moving average methods are used. First, basic data of medical services are collected, then all medical activities are confirmed and all service costs are collected, then a cost database is established, and a calculation model of medical costs is designed. Finally, calculation suggestions and optimization methods are put forward by analyzing the calculated data. The experimental results show that the actual demand of drugs predicted by the general moving average method is relatively insufficient, with the maximum error of 41%, the minimum of 5%, and the average error of 19.8%; the maximum error of drug demand predicted by the weighted moving average method is 24%, the minimum is 2%, and the average is 15.4%. It can be concluded that the prediction effect of the weighted moving average method is better than that of the ordinary moving average method, which plays a good and effective role in the prediction of medical cost. The activity-based costing method is more detailed and organized for the cost calculation and classification of medical services. It provides a certain value for the effective management and control of medical service cost.
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Mondor L, Watson T, Kornas K, Bornbaum C, Wodchis WP, Rosella LC. Direct and indirect pathways between low income status and becoming a high-cost health care user in Ontario, Canada: a mediation analysis of health risk behaviors. Ann Epidemiol 2020; 51:28-34.e4. [PMID: 32739531 DOI: 10.1016/j.annepidem.2020.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 06/29/2020] [Accepted: 07/13/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE We investigated natural direct and indirect pathways between low-income status and high-cost user (HCU) transitions considering health risk behaviors as potential mediators. METHODS We analyzed data from respondents (aged 18+) from four pooled cycles of the Canadian Community Health Survey (2005-2010/2011) linked to administrative data in Ontario, Canada. HCUs were defined as the top 5% of the population, ranked by cost consumption in any of the five years after survey interview. Low-income status was defined from the provincial distribution of self-reported household income, with missing values imputed from neighborhood-level data. In mediation analyses based on marginal structural models, we quantified the contributions of smoking, physical inactivity, alcohol consumption, and body mass index to income-HCU associations. RESULTS 115,091 respondents (representative of 9,661,764 Ontarians) were included in the study, of which 7.2% became HCUs. The odds of becoming HCUs were 1.36 times (95% CI: 1.25-1.48) greater for low (vs. high) income status respondents. Smoking, physical activity, alcohol consumption, and body mass index contributed 9.4%, 6.5%, 10.6%, and 4.4% to this association, respectively. Tests for exposure-mediator interactions were not statistically significant. CONCLUSIONS Health risk behaviors only partially explain income inequalities in future HCU transitions.
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Affiliation(s)
- Luke Mondor
- ICES, Toronto, Ontario, Canada; Health System Performance Network, Toronto, Ontario, Canada
| | | | - Kathy Kornas
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Catherine Bornbaum
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Walter P Wodchis
- ICES, Toronto, Ontario, Canada; Health System Performance Network, Toronto, Ontario, Canada; Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Laura C Rosella
- ICES, Toronto, Ontario, Canada; Health System Performance Network, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Public Health Ontario, Toronto, Ontario, Canada.
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Tanner JA, Hensel J, Davies PE, Brown LC, Dechairo BM, Mulsant BH. Economic Burden of Depression and Associated Resource Use in Manitoba, Canada. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2020; 65:338-346. [PMID: 31835904 PMCID: PMC7265616 DOI: 10.1177/0706743719895342] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVES To characterize the health-care utilization and economic burden associated with depression in Manitoba, Canada. METHODS Patient-level data were retrieved from the Manitoba Centre for Health Policy administrative, clinical, and laboratory databases for the study period of January 1, 1996, through December 31, 2016. Patients were assigned to the depression cohort based on diagnoses recorded in hospitalizations and outpatient physician claims, as well as antidepressant prescription drug claims. A comparison cohort of nondepressed subjects, matched with replacement for age, gender, place of residence (urban vs. rural), and index date, was created. Demographics, comorbidities, intentional self-harm, mortality, health-care utilization, prescription drug utilization, and costs of health-care utilization and social services were compared between depressed patients and matched nondepressed patients, and incidence rate ratios and hazard ratios were reported. RESULTS There were 190,065 patients in the depression cohort and 378,177 patients in the nondepression cohort. Comorbidities were 43% more prevalent among depressed patients. Intentional self-harm, all-cause mortality, and suicide mortality were higher among patients with depression than the nondepression cohort. Health-care utilization-including hospitalizations, physician visits, physician-provided psychotherapy, and prescription drugs-was higher in the depression than the nondepression cohort. Mean health-care utilization costs were 3.5 times higher among depressed patients than nondepressed patients ($10,064 and $2,832, respectively). Similarly, mean social services costs were 3 times higher ($1,522 and $510, respectively). Overall, depression adds a total average cost of $8,244 (SD = $40,542) per person per year. CONCLUSIONS Depression contributes significantly to health burden and per patient costs in Manitoba, Canada. Extrapolation of the results to the entire Canadian health-care system projects an excess of $12 billion annually in health system spending.
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Affiliation(s)
- Julie-Anne Tanner
- Tanenbaum Pharmacogenetics Centre, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
- Department of Psychiatry, University of Toronto, Ontario, Canada
- Assurex Health Ltd., Toronto, Ontario, Canada
| | - Jennifer Hensel
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | | | | | - Benoit H. Mulsant
- Department of Psychiatry, University of Toronto, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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Rautiainen E, Ryynänen OP, Laatikainen T, Kekolahti P. Factors Associated with 5-Year Costs of Care among a Cohort of Alcohol Use Disorder Patients: A Bayesian Network Model. Healthc Inform Res 2020; 26:129-145. [PMID: 32547810 PMCID: PMC7278506 DOI: 10.4258/hir.2020.26.2.129] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 03/23/2020] [Accepted: 04/16/2020] [Indexed: 11/23/2022] Open
Abstract
Objectives To examine the direct effects of risk factors associated with the 5-year costs of care in persons with alcohol use disorder (AUD) and to examine whether remission decreases the costs of care. Methods Based on Electronic Health Record data collected in the North Karelia region in Finland from 2012 to 2016, we built a non-causal augmented naïve Bayesian (ANB) network model to examine the directional relationship between 16 risk factors and the costs of care for a random cohort of 363 AUD patients. Jouffe’s proprietary likelihood matching algorithm and van der Weele’s disjunctive confounder criteria (DCC) were used to calculate the direct effects of the variables, and sensitivity analysis with tornado diagrams and analysis maximizing/minimizing the total cost of care were conducted. Results The highest direct effect on the total cost of care was observed for a number of chronic conditions, indicating on average more than a €26,000 increase in the 5-year mean cost for individuals with multiple ICD-10 diagnoses compared to individuals with less than two chronic conditions. Remission had a decreasing effect on the total cost accumulation during the 5-year follow-up period; the percentage of the lowest cost quartile (42.9% vs. 23.9%) increased among remitters, and that of the highest cost quartile (10.71% vs. 26.27%) decreased compared with current drinkers. Conclusions The ANB model with application of DCC identified that remission has a favorable causal effect on the total cost accumulation. A high number of chronic conditions was the main contributor to excess cost of care, indicating that comorbidity is an essential mediator of cost accumulation in AUD patients.
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Affiliation(s)
- Elina Rautiainen
- Department of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.,Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Olli-Pekka Ryynänen
- Department of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.,General Practice Unit, Kuopio University Hospital, Primary Health Care, Kuopio, Finland
| | - Tiina Laatikainen
- Department of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.,Finnish Institute for Health and Welfare, Helsinki, Finland.,Joint Municipal Authority for North Karelia Social and Health Services (Siun sote), Joensuu, Finland
| | - Pekka Kekolahti
- Department of Communications and Networking, School of Electrical Engineering, Aalto University, Espoo, Finland
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Booth RG, Richard L, Li L, Shariff SZ, Rayner J. Characteristics of health care related to mental health and substance use disorders among Community Health Centre clients in Ontario: a population-based cohort study. CMAJ Open 2020; 8:E391-E399. [PMID: 32447281 PMCID: PMC7252687 DOI: 10.9778/cmajo.20190089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Community Health Centre (CHC) client populations with a history of mental illness or substance use disorders, or both, are not described well in the literature. We identified CHC clients in Ontario with a history of health care related to mental health or substance use disorders, or both, and describe their demographic characteristics, health system use and related health risks in comparison to other people in the province with similar diagnoses who did not use CHC services. METHODS We conducted a population-based cohort study using provincial health administrative data among Ontario residents aged 21-105 years with a previously established medical history of a mental illness or substance use disorder, or both. We examined 3 groups: clients of CHC sites that serve at-risk priority populations (PPCHCs) who presented for care at a CHC between Apr. 1, 2014, and Mar. 31, 2015, clients of CHC sites that serve nonpriority populations (NPPCHCs) who presented for care at a CHC over the same period, and a community control group of patients with a history of health care use related to mental illness or substance use disorders, or both, in the 2 years before the index date who were not CHC clients. We used descriptive statistics and multivariable logistic regression to estimate the odds of psychiatric care and emergency department use within 1 year of the index date. RESULTS Compared to the community control patients (n = 1 673 200), clients of PPCHCs (n = 6575) and NPPCHCs (n = 15 208) were younger, experienced more residential instability and had an increased prevalence of medical comorbidities; they had higher odds of receiving care from a psychiatrist (adjusted odds ratio [OR] 1.26, 95% confidence interval [CI] 1.20-1.33, and 1.47, 95% CI 1.41-1.53, respectively) and visiting an emergency department (adjusted OR 1.15, 95% CI 1.10-1.20, and 1.13, 95% CI 1.09-1.17, respectively) in the 1-year follow-up period. INTERPRETATION Ontario CHC clients with mental health or substance use disorders had medically complex needs and were intensive users of the health care system. Specific interventions should be developed to better serve this vulnerable population.
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Affiliation(s)
- Richard G Booth
- Arthur Labatt Family School of Nursing (Booth), Western University; ICES Western (Richard, Li, Shariff), London, Ont.; Alliance for Healthier Communities (Rayner), Toronto, Ont
| | - Lucie Richard
- Arthur Labatt Family School of Nursing (Booth), Western University; ICES Western (Richard, Li, Shariff), London, Ont.; Alliance for Healthier Communities (Rayner), Toronto, Ont
| | - Lihua Li
- Arthur Labatt Family School of Nursing (Booth), Western University; ICES Western (Richard, Li, Shariff), London, Ont.; Alliance for Healthier Communities (Rayner), Toronto, Ont
| | - Salimah Z Shariff
- Arthur Labatt Family School of Nursing (Booth), Western University; ICES Western (Richard, Li, Shariff), London, Ont.; Alliance for Healthier Communities (Rayner), Toronto, Ont
| | - Jennifer Rayner
- Arthur Labatt Family School of Nursing (Booth), Western University; ICES Western (Richard, Li, Shariff), London, Ont.; Alliance for Healthier Communities (Rayner), Toronto, Ont
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Penzenstadler L, Gentil L, Huỳnh C, Grenier G, Fleury MJ. Variables associated with low, moderate and high emergency department use among patients with substance-related disorders. Drug Alcohol Depend 2020; 207:107817. [PMID: 31887605 DOI: 10.1016/j.drugalcdep.2019.107817] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 12/12/2019] [Accepted: 12/14/2019] [Indexed: 11/27/2022]
Abstract
AIMS This study identified factors associated with frequency of emergency department (ED) use for medical reasons among patients with substance-related disorders (SRD) in Quebec (Canada) for 2014-15. METHODS Participants (n = 4731) were categorized as: 1) low (1 visit/year), 2) moderate (2 visits/year), and 3) high (3+ visits/year) ED users. Independent variables included predisposing, enabling and needs factors based on the Andersen Behavioral Model. Multinomial logistic regression identified associated variables. RESULTS Factors positively associated with moderate and high ED use included adjustment disorders, suicidal behavior, alcohol-induced disorders, less urgent to non-urgent illness acuity, referral to local health community services centers (LHCSC) at discharge, and living in a materially deprived area. Factors positively associated with high ED use only included anxiety disorders, alcohol use disorders, drug use disorders, chronic physical illness, subacute problems, prior ED use for MD and/or SRD, prior LHCSC medical interventions, physician consultation within one month after discharge, living in very deprived or middle-class areas, and, negatively, being hospitalized for medical reasons in second ED visit. Moderate ED use only was negatively associated with alcohol intoxication and being referred to a GP at ED discharge. CONCLUSIONS Compared to low ED users, most high users with SRD were men presenting more complex and severe conditions. They visited ED mainly for subacute or non-urgent problems. Compared to low ED users, most moderate users had alcohol-induced disorders, less alcohol intoxication, and acute common MD. They visited ED mainly for non-urgent care. Diverse strategies should be implemented to reduce ED visits, targeting each group.
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Affiliation(s)
- Louise Penzenstadler
- Douglas Mental Health University Institute (Research Centre), McGill University, Department of Psychiatry, 6875 LaSalle Boulevard, Montréal, Québec H4H 1R3, Canada; Service d'addictologie, Département de psychiatrie, Hôpitaux Universitaires Genève, Rue du Grand-Pré 70c, 1202 Genève, Switzerland
| | - Lia Gentil
- Douglas Mental Health University Institute (Research Centre), McGill University, Department of Psychiatry, 6875 LaSalle Boulevard, Montréal, Québec H4H 1R3, Canada; Institut universitaire sur les dépendances, Centre intégré universitaire de santé et des services sociaux du Centre-Sud-de-l'Île-de-Montréal, 950 Louvain East, Montréal, Québec H2M 2E8, Canada
| | - Christophe Huỳnh
- Institut universitaire sur les dépendances, Centre intégré universitaire de santé et des services sociaux du Centre-Sud-de-l'Île-de-Montréal, 950 Louvain East, Montréal, Québec H2M 2E8, Canada
| | - Guy Grenier
- Douglas Mental Health University Institute (Research Centre), McGill University, Department of Psychiatry, 6875 LaSalle Boulevard, Montréal, Québec H4H 1R3, Canada
| | - Marie-Josée Fleury
- Douglas Mental Health University Institute (Research Centre), McGill University, Department of Psychiatry, 6875 LaSalle Boulevard, Montréal, Québec H4H 1R3, Canada.
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10
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Hensel JM, Taylor VH, Fung K, Yang R, Vigod SN. Acute Care Use for Ambulatory Care-Sensitive Conditions in High-Cost Users of Medical Care with Mental Illness and Addictions. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2018; 63:816-825. [PMID: 29347834 PMCID: PMC6309042 DOI: 10.1177/0706743717752880] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The role of mental illness and addiction in acute care use for chronic medical conditions that are sensitive to ambulatory care management requires focussed attention. This study examines how mental illness or addiction affects risk for repeat hospitalization and/or emergency department use for ambulatory care-sensitive conditions (ACSCs) among high-cost users of medical care. METHOD A retrospective, population-based cohort study using data from Ontario, Canada. Among the top 10% of medical care users ranked by cost, we determined rates of any and repeat care use (hospitalizations and emergency department [ED] visits) between April 1, 2011, and March 31, 2012, for 14 consensus established ACSCs and compared them between those with and without diagnosed mental illness or addiction during the 2 years prior. Risk ratios were adjusted (aRR) for age, sex, residence, and income quintile. RESULTS Among 314,936 high-cost users, 35.9% had a mental illness or addiction. Compared to those without, individuals with mental illness or addiction were more likely to have an ED visit or hospitalization for any ACSC (22.8% vs. 19.6%; aRR, 1.21; 95% confidence interval [CI], 1.20-1.23). They were also more likely to have repeat ED visits or hospitalizations for the same ACSC (6.2% vs. 4.4% of those without; aRR, 1.48; 95% CI, 1.44-1.53). These associations were stronger in stratifications by mental illness diagnostic subgroup, particularly for those with a major mental illness. CONCLUSIONS The presence of mental illness and addiction among high-cost users of medical services may represent an unmet need for quality ambulatory and primary care.
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Affiliation(s)
- Jennifer M Hensel
- Department of Psychiatry, Women's College Hospital and University of Toronto, Toronto, Ontario.,Women's College Institute for Health Systems Solutions and Virtual Care, Toronto, Ontario
| | - Valerie H Taylor
- Department of Psychiatry, Women's College Hospital and University of Toronto, Toronto, Ontario
| | - Kinwah Fung
- Institute for Clinical Evaluative Sciences, Toronto, Ontario
| | - Rebecca Yang
- Women's College Institute for Health Systems Solutions and Virtual Care, Toronto, Ontario
| | - Simone N Vigod
- Department of Psychiatry, Women's College Hospital and University of Toronto, Toronto, Ontario.,Institute for Clinical Evaluative Sciences, Toronto, Ontario
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Anderson M, Revie CW, Quail JM, Wodchis W, de Oliveira C, Osman M, Baetz M, McClure J, Stryhn H, Buckeridge D, Neudorf C. The effect of socio-demographic factors on mental health and addiction high-cost use: a retrospective, population-based study in Saskatchewan. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2018; 109:810-820. [PMID: 29981109 PMCID: PMC6267642 DOI: 10.17269/s41997-018-0101-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 06/07/2018] [Indexed: 01/12/2023]
Abstract
OBJECTIVE A small proportion of the population accounts for the majority of healthcare costs. Mental health and addiction (MHA) patients are consistently high-cost. We aimed to delineate factors amenable to public health action that may reduce high-cost use among a cohort of MHA clients in Saskatoon, Saskatchewan. METHODS We conducted a population-based retrospective cohort study. Administrative health data from fiscal years (FY) 2009-2015, linked at the individual level, were analyzed (n = 129,932). The outcome of interest was ≥ 90th percentile of costs for each year under study ('persistent high-cost use'). Descriptive analyses were followed by logistic regression modelling; the latter excluded long-term care residents. RESULTS The average healthcare cost among study cohort members in FY 2009 was ~ $2300; for high-cost users it was ~ $19,000. Individuals with unstable housing and hospitalization(s) had increased risk of persistent high-cost use; both of these effects were more pronounced as comorbidities increased. Patients with schizophrenia, particularly those under 50 years old, had increased probability of persistent high-cost use. The probability of persistent high-cost use decreased with good connection to a primary care provider; this effect was more pronounced as the number of mental health conditions increased. CONCLUSION Despite constituting only 5% of the study cohort, persistent high-cost MHA clients (n = 6455) accounted for ~ 35% of total costs. Efforts to reduce high-cost use should focus on reduction of multimorbidity, connection to a primary care provider (particularly for those with more than one MHA), young patients with schizophrenia, and adequately addressing housing stability.
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Affiliation(s)
- Maureen Anderson
- Department of Health Management, Atlantic Veterinary College, University of Prince Edward Island, 550 University Avenue, Charlottetown, PE, C1A 4P3, Canada.
- Saskatchewan Health Quality Council, Atrium Building, Innovation Place, 241 - 111 Research Drive, Saskatoon, SK, S7N 3R2, Canada.
| | - Crawford W Revie
- Department of Health Management, Atlantic Veterinary College, University of Prince Edward Island, 550 University Avenue, Charlottetown, PE, C1A 4P3, Canada
| | - Jacqueline M Quail
- Saskatchewan Health Quality Council, Atrium Building, Innovation Place, 241 - 111 Research Drive, Saskatoon, SK, S7N 3R2, Canada
- College of Medicine, University of Saskatchewan, 107 Wiggins Road, Saskatoon, SK, S7N 5E5, Canada
| | - Walter Wodchis
- Institute of Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building 155 College Street, Suite 425, Toronto, ON, M5T 3M6, Canada
- Institute for Clinical Evaluative Sciences, 2075 Bayview Ave., Toronto, ON, M4N 3M5, Canada
| | - Claire de Oliveira
- Institute of Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building 155 College Street, Suite 425, Toronto, ON, M5T 3M6, Canada
- Institute for Clinical Evaluative Sciences, 2075 Bayview Ave., Toronto, ON, M4N 3M5, Canada
- Centre for Addiction and Mental Health, 1001 Queen Street West, Toronto, ON, M6J 1H4, Canada
| | - Meriç Osman
- Saskatchewan Health Quality Council, Atrium Building, Innovation Place, 241 - 111 Research Drive, Saskatoon, SK, S7N 3R2, Canada
| | - Marilyn Baetz
- College of Medicine, University of Saskatchewan, 107 Wiggins Road, Saskatoon, SK, S7N 5E5, Canada
- Saskatoon Health Region, #101-310 Idylwyld Drive North, Saskatoon, SK, S7L 0Z2, Canada
| | - J McClure
- Department of Health Management, Atlantic Veterinary College, University of Prince Edward Island, 550 University Avenue, Charlottetown, PE, C1A 4P3, Canada
| | - Henrik Stryhn
- Department of Health Management, Atlantic Veterinary College, University of Prince Edward Island, 550 University Avenue, Charlottetown, PE, C1A 4P3, Canada
| | - David Buckeridge
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Purvis Hall 1020 Pine Avenue West, Montreal, QC, H3A 1A2, Canada
| | - Cordell Neudorf
- College of Medicine, University of Saskatchewan, 107 Wiggins Road, Saskatoon, SK, S7N 5E5, Canada
- Saskatoon Health Region, #101-310 Idylwyld Drive North, Saskatoon, SK, S7L 0Z2, Canada
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12
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Wammes JJG, van der Wees PJ, Tanke MAC, Westert GP, Jeurissen PPT. Systematic review of high-cost patients' characteristics and healthcare utilisation. BMJ Open 2018; 8:e023113. [PMID: 30196269 PMCID: PMC6129088 DOI: 10.1136/bmjopen-2018-023113] [Citation(s) in RCA: 153] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 06/05/2018] [Accepted: 07/17/2018] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES To investigate the characteristics and healthcare utilisation of high-cost patients and to compare high-cost patients across payers and countries. DESIGN Systematic review. DATA SOURCES PubMed and Embase databases were searched until 30 October 2017. ELIGIBILITY CRITERIA AND OUTCOMES Our final search was built on three themes: 'high-cost', 'patients', and 'cost' and 'cost analysis'. We included articles that reported characteristics and utilisation of the top-X% (eg, top-5% and top-10%) patients of costs of a given population. Analyses were limited to studies that covered a broad range of services, across the continuum of care. Andersen's behavioural model was used to categorise characteristics and determinants into predisposing, enabling and need characteristics. RESULTS The studies pointed to a high prevalence of multiple (chronic) conditions to explain high-cost patients' utilisation. Besides, we found a high prevalence of mental illness across all studies and a prevalence higher than 30% in US Medicaid and total population studies. Furthermore, we found that high costs were associated with increasing age but that still more than halve of high-cost patients were younger than 65 years. High costs were associated with higher incomes in the USA but with lower incomes elsewhere. Preventable spending was estimated at maximally 10% of spending. The top-10%, top-5% and top-1% high-cost patients accounted for respectively 68%, 55% and 24% of costs within a given year. Spending persistency varied between 24% and 48%. Finally, we found that no more than 30% of high-cost patients are in their last year of life. CONCLUSIONS High-cost patients make up the sickest and most complex populations, and their high utilisation is primarily explained by high levels of chronic and mental illness. High-cost patients are diverse populations and vary across payer types and countries. Tailored interventions are needed to meet the needs of high-cost patients and to avoid waste of scarce resources.
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Affiliation(s)
- Joost Johan Godert Wammes
- Radboud University Medical Center, Scientific Center for Quality of Healthcare/Celsus Academy for Sustainable Healthcare, Nijmegen, The Netherlands
| | - Philip J van der Wees
- Radboud University Medical Center, Scientific Center for Quality of Healthcare/Celsus Academy for Sustainable Healthcare, Nijmegen, The Netherlands
| | - Marit A C Tanke
- Radboud University Medical Center, Scientific Center for Quality of Healthcare/Celsus Academy for Sustainable Healthcare, Nijmegen, The Netherlands
| | - Gert P Westert
- Radboud University Medical Center, Scientific Center for Quality of Healthcare, Nijmegen, The Netherlands
| | - Patrick P T Jeurissen
- Radboud University Medical Center, Scientific Center for Quality of Healthcare/Celsus Academy for Sustainable Healthcare, Nijmegen, The Netherlands
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Hensel JM, Taylor VH, Fung K, de Oliveira C, Vigod SN. Unique Characteristics of High-Cost Users of Medical Care With Comorbid Mental Illness or Addiction in a Population-Based Cohort. PSYCHOSOMATICS 2017; 59:135-143. [PMID: 29157683 DOI: 10.1016/j.psym.2017.10.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 10/11/2017] [Accepted: 10/12/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To understand whether high-cost users of medical care with and without comorbid mental illness or addiction differ in terms of their sociodemographic and health characteristics. Unique characteristics would warrant different considerations for interventions and service design aimed at reducing unnecessary health care utilization and associated costs. METHODS From the top 10% of Ontarians ranked by total medical care costs during fiscal year 2011/2012 (N = 314,936), prior 2-year mental illness or addiction diagnoses were determined from administrative data. Sociodemographics, medical illness characteristics, medical costs, and utilization were compared between those high-cost users of medical care with and without comorbid mental illness or addiction. Odds of being a frequent user of inpatient (≥3 admissions) and emergency (≥5 visits) services were compared between groups, adjusting for age, sex, socioeconomic status and medical illness characteristics. RESULTS High-cost users of medical care with comorbid mental illness or addiction were younger, had a lower socioeconomic status, had greater historical medical morbidity, and had higher total medical care costs (mean excess of $2,031/user) than those without. They were more likely to be frequent users of inpatient (12.8% vs 10.2%; adjusted OR, 1.14; 95% CI: 1.12-1.17) and emergency (8.4% vs 4.8%; adjusted OR, 1.55; 95% CI: 1.50-1.59) services. Effect sizes were larger in major mood, psychotic, and substance use disorder subgroups. CONCLUSIONS High-cost medical care users with mental illness or addiction have unique characteristics with respect to sociodemographics and service utilization patterns to consider in interventions and policies for this patient group.
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Affiliation(s)
- Jennifer M Hensel
- Department of Psychiatry, Women's College Hospital, Toronto, Canada; Women's College Research Institute, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada.
| | - Valerie H Taylor
- Department of Psychiatry, Women's College Hospital, Toronto, Canada; Women's College Research Institute, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Kinwah Fung
- Women's College Research Institute, Toronto, Canada; Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - Claire de Oliveira
- Institute for Clinical Evaluative Sciences, Toronto, Canada; Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada; Centre for Addiction and Mental Health, Toronto, Canada
| | - Simone N Vigod
- Department of Psychiatry, Women's College Hospital, Toronto, Canada; Women's College Research Institute, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada; Institute for Clinical Evaluative Sciences, Toronto, Canada; Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
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