One-year Healthcare Utilization Research Articles

One-Year Healthcare Utilization and Expenditures Among Patients with Clinically Significant Mitral Regurgitation in Taiwan.

Mitral regurgitation (MR) is characterized by systolic blood flow reversal from the left ventricle to the left atrium. A 2019 study indicated that in the USA, clinically significant MR (sMR) is associated with a substantial healthcare cost burden. In Taiwan, few data are available to describe the clinical characteristics, treatment patterns, and economic burden of patients with sMR. Using the National Health Insurance Research Database (NHIRD), a national, detailed claims database of all 23 million residents of Taiwan, we conducted a retrospective cohort study to identify patients with sMR and quantify the impact of the disease on Taiwan's healthcare system. We classified patients with sMR into three cohorts based on disease etiology: functional MR (sFMR), degenerative MR (sDMR), and uncharacterized MR (sUMR). We compared patient characteristics across cohorts and estimated attributable healthcare utilization and costs during the 12-month follow-up period. Our research shows that in Taiwan, patients with sFMR were older, sicker, and presented at casualty (emergency department) more frequently than those with sDMR and sUMR. Meanwhile, patients with sDMR had the highest 12-month healthcare expenditures across the cohorts. These findings are inconsistent with what has been shown in the USA, which warrants further investigation.

Physical Function Transitions and Healthcare Utilization Among Older Mexican Americans.

The aim of this study was to examine the relationship between 2-year physical function transitions and one-year healthcare utilization among Mexican American Medicare beneficiaries. The sample consisted of 429 Mexican Americans ≥75 years old from the Hispanic Established Population for the Epidemiologic Study of the Elderly linked with Medicare claims data from the Centers for Medicare and Medicaid Services. Short Physical Performance Battery (SPPB) from Wave 5 (2004/05) to Wave 6 was used to create physical function transition groups. The outcomes were physician visits (<6, 6-12, >12 visits), number of emergency room visits, and number of acute hospitalizations one-year after physical function transitions. Multinomial logistic regression and Generalized Estimating Equation with negative binomial distribution were used to estimate the odds ratio of healthcare utilization as a function of physical function transition groups, controlling for socio-demographics and comorbidities. Participants who improved or remained moderate-high physical function had lower odds ratio (OR) of being hospitalized (0.40, 95% Confidence Interval [CI]=(0.18, 0.90)) or visiting the emergency room (OR=0.52, 95% CI=0.32-0.84) one-year later compared to participants who remained in the low physical function group. No difference in physician visits across physical function transition groups was found. This study showed healthcare utilization differed by physical function transition groups among Mexican American Medicare beneficiaries. Physical function improvement or maintenance of moderate-high physical function should be targeted in older Mexican Americans, a population at great risk of developing disability, to reduce or delay dependency and healthcare burden.

One-Year Health Care Utilization and Recurrence After Incisional Hernia Repair in the United States: A Population-Based Study Using the Nationwide Readmission Database

BackgroundMost data on health care utilization after incisional hernia (IH) repair are limited to 30-days and are not nationally representative. We sought to describe nationwide 1-year readmission burden after IH repair (IHR). MethodsPatients undergoing elective IHR discharged alive were identified using the 2010-2014 Nationwide Readmission Database. Transfers and incomplete follow-up were excluded. Descriptive statistics were used to describe rates of 1-year readmission, IH recurrence, and bowel obstruction. Cox regression allowed identification of factors associated with 1-year readmissions. Generalized linear models were used to estimate predicted mean difference in cumulative costs/year, which allowed estimation of IHR readmission costs/year nationwide. ResultsOf 15,935 identified patients, 19.35% were readmitted within 1 y. Patients who were readmitted differed by insurance, Charlson index, illness severity, smoking status, disposition, and surgical approach compared with those who were not (P < 0.05). Of readmitted patients, 39.3% returned within 30 d; 50.9% and 25.6% were due to any and infectious complications, respectively; 25.6% presented to a different hospital; 35.4% required reoperation; 5.4% experienced bowel obstruction; and 5% had IHR revision. Factors associated with readmissions included Medicare (hazard ratio [HR] 1.46 [95% confidence interval 1.19-1.8]; P < 0.01) or Medicaid (HR 1.42 [1.12-1.8], P < 0.01); chronic pulmonary disease (1.38 [1.17-1.64], P < 0.01), and anemia (1.36, [1.05-1.75], P = 0.02). Readmitted patients had higher 1-year cumulative costs (predicted mean difference $12,190 [95% CI: 10,941-13,438]; P < 0.01). Nationwide cost related to readmissions totaled $90,196,248/y. ConclusionsOne-year readmissions after IHR are prevalent and most commonly due to postoperative complications, especially infections. One-third of readmitted patients require a subsequent operation, and 5% experience IH recurrence, intensifying the burden to patients and on the health care system.

Ninety-day and one-year healthcare utilization and costs after knee arthroplasty

This study examined ninety-day and one-year postoperative healthcare utilization and costs following total knee arthroplasty (TKA) from the health sector and patient perspectives. This study relied on: 1) patient-reported medical resource utilization data from diaries in the Knee Arthroplasty Pain Coping Skills Training (KASTPain) trial; and 2) Medicare fee schedules. Medicare payments, patient cost-sharing, and patient time costs were estimated. Generalized linear mixed models were used to identify baseline predictors of costs. In the first ninety days following TKA, patients had an average of 29.7 outpatient visits and 6% were hospitalized. Mean total costs during this period summed to $3,720, the majority attributed to outpatient visit costs (84%). Over the year following TKA, patients had an average of 48.9 outpatient visits, including 33.2 for physical therapy. About a quarter (24%) of patients were hospitalized. Medical costs were incurred at a decreasing rate, from $2,428 in the first six weeks to $648 in the last six weeks. Mean total medical costs across all patients over the year were $8,930, including $5,328 in outpatient costs. Total costs were positively associated with baseline Charlson comorbidity score (P<0.01). Outpatient costs were positively associated with baseline Charlson comorbidity score (P=0.03) and a bodily pain burden summary score (P<0.01). Mean patient cost-sharing summed to $1,342 and time costs summed to $1,346. Costs in the ninety days and year after TKA can be substantial for both healthcare payers and patients. These costs should be considered as payers continue to explore alternative payment models.