Abstract
BackgroundA small proportion of patients account for the majority of health care spending. The objectives of this study were to explore the clinical characteristics, patterns of health care use, and the proportion of acute care spending deemed potentially preventable among high cost inpatients within a Canadian acute-care hospital.MethodsWe identified all individuals within the Ottawa Hospital with one or more inpatient hospitalization between April 1, 2010 and March 31, 2011. Clinical characteristics and frequency of hospital encounters were captured in the information systems of the Ottawa Hospital Data Warehouse. Direct inpatient costs for each encounter were summed using case costing information and those in the upper first and fifth percentiles of the cumulative direct cost distribution were defined as extremely high cost and high cost respectively. We quantified preventable acute care spending as hospitalizations for ambulatory care sensitive conditions (ACSC) and spending attributable to difficulty discharging patients as measured by alternate level of care (ALC) status.ResultsDuring the study period, 36,892 patients had 44,066 hospitalizations. High cost patients (n = 1,844) accounted for 38 % of total inpatient spending ($122 million) and were older, more likely to be male, and had higher levels of co-morbidity compared to non-high cost patients. In over half of the high cost cohort (54 %), costs were accumulated from a single hospitalization. The majority of costs were related to nursing care and intensive care unit spending. High cost patients were more likely to have an encounter deemed to be ambulatory care sensitive compared to non-high cost inpatients (6.0 versus 2.8 %, p < 0.001). A greater proportion of inpatient spending was attributable to ALC days for high cost versus non-high cost patients (9.1 versus 4.9 %, p < 0.001).ConclusionsWithin a population of high cost inpatients, the majority of costs are attributed to a single, non-preventable, acute care episode. However, there are likely opportunities to improve hospital efficiency by focusing on different approaches to community based care directed towards specific populations.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1418-2) contains supplementary material, which is available to authorized users.
Highlights
A small proportion of patients account for the majority of health care spending
This limits our understanding of how costs are accumulated, the specific resources that contribute to overall costing estimates, and the proportion of inpatient spending deemed potentially preventable among high cost inpatients
The proportion of high cost patients with at least one intensive care unit (ICU) admission was larger than the non-high cost comparator (48.4 versus 7.1 %) and high cost patients were more likely to have alternate level of care (ALC) days during their hospital encounter (33.2 versus 2.7 %)
Summary
A small proportion of patients account for the majority of health care spending. The objectives of this study were to explore the clinical characteristics, patterns of health care use, and the proportion of acute care spending deemed potentially preventable among high cost inpatients within a Canadian acute-care hospital. Few studies have assessed the hospital resources most commonly used during high cost encounters; rather they look at overall costs This limits our understanding of how costs are accumulated, the specific resources that contribute to overall costing estimates, and the proportion of inpatient spending deemed potentially preventable among high cost inpatients. While the latter has recently been studied by Joynt et al, within an American Medicare population, it is unclear how these results translate to other settings with different funding models, like we have in Canada [5]
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