Health care utilization and potentially preventable adverse outcomes of high-need, high-cost middle-aged and older adults: Needs for integrated care models with life-course approach

被引:16
作者
Meng, Lin-Chieh [1 ]
Huang, Shih-Tsung [2 ]
Chen, Ho-Min [3 ]
Hashmi, Ardeshir Z. [4 ]
Hsiao, Fei-Yuan [1 ,5 ,6 ,9 ]
Chen, Liang-Kung [2 ,7 ,8 ,10 ]
机构
[1] Natl Taiwan Univ, Grad Inst Clin Pharm, Coll Med, Taipei, Taiwan
[2] Natl Yang Ming Chiao Tung Univ, Ctr Hlth Longev & Aging Sci, Taipei, Taiwan
[3] Natl Taiwan Univ, Hlth Data Res Ctr, Taipei, Taiwan
[4] Cleveland Clin, Ctr Geriatr Med, Cleveland Hts, OH USA
[5] Natl Taiwan Univ Hosp, Dept Pharm, Taipei, Taiwan
[6] Natl Taiwan Univ, Coll Med, Sch Pharm, Taipei, Taiwan
[7] Taipei Vet Gen Hosp, Ctr Geriatr & Gerontol, Taipei, Taiwan
[8] Taipei Municipal Gan Dau Hosp, Managed Taipei Vet Gen Hosp, Taipei, Taiwan
[9] Natl Taiwan Univ, Grad Inst Clin Pharm, Coll Med, Room 220,33,Linsen S Rd, Taipei 10050, Taiwan
[10] Taipei Vet Gen Hosp, Ctr Geriatr & Gerontol, Sec 2 Shih Pai Rd, Taipei 201, Taiwan
关键词
High-need high-cost (HNHC); Health care utilization; Preventable hospitalization; Preventable emergency department visit; Mortality; POLYPHARMACY; POPULATION; MORBIDITY; BURDEN;
D O I
10.1016/j.archger.2023.104956
中图分类号
R592 [老年病学]; C [社会科学总论];
学科分类号
03 ; 0303 ; 100203 ;
摘要
Purpose of the research: The success of modern health care increases life expectancy and prolongs the days of having multimorbidity and functional limitations; the so-defined "high need, high cost (HNHC)" state represents the extreme scenarios of care burden and complexity. This study aims to explore health care utilization and the risk of preventable adverse outcomes stratified by age and HNHC state.Materials and methods: We conducted a retrospective cohort study using the National Health Insurance (NHI) database. People aged >= 40 years were included and further stratified by age (middle-aged: 40-64 and older adults: 65) and HNHC state (top 10% of spending). Health care utilization and drug consumption across different groups were obtained. The multimorbidity frailty index (mFI) was developed for further analysis. Cox regression models were used to examine the associations between HNHC and adverse clinical outcomes (preventable hospitalizations, preventable emergency department visits, and mortality).Results: HNHC participants were older, had a higher mFI and drug consumption, and had higher health care utilization. Compared with non-HNHC participants, HNHC participants exhibited a 4.4-fold and 2.4-fold higher risk of preventable hospitalizations in middle-aged (HR=4.41; 95% CI, 4.17-4.65, p<0.01) and older adults (HR=2.44; 95% CI, 2.34-2.55, p<0.01). Similar risks were observed for preventable emergency department visits and mortality (all p<0.01).Conclusions: The HNHC state substantially increased health care utilization, polypharmacy, and potentially preventable adverse outcomes after adjustment for frailty. Intervention studies developing integrated care models using the life-course approach are needed to improve the quality of health care systems in super-aged societies.
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页数:10
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