Association of Comorbidities with Healthcare Resource Utilization and Cost for Post-discharge Heart Failure Patients with Chronic Kidney Disease PDF Download
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Author: Qixin Li
Publisher:
ISBN:
Category :
Languages : en
Pages : 0
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Book Description
Heart failure is a serious and incurable condition that often coexists with chronic kidney disease. Approximately 83% of patients were hospitalized after their HF diagnosis, accounting for the majority of their medical costs. Numerous studies have reported that comorbidities are associated with HF hospitalization and costs. However, no study has been found so far that investigates the incremental economic burden of commonly reported comorbidities, namely diabetes, hypertension and coronary heart disease of post-discharge HF patients with chronic kidney disease. To assess the incremental healthcare resource utilization and costs associated with additional comorbidities among post-discharge heart failure patients with chronic kidney disease, at 30-day and 1-year post discharge. This retrospective cohort analysis was conducted using the IBM® Watson MarketScan® Commercial Claims and Encounters and Medicare Supplemental databases. Our population of interest was adult patients discharged after a HF hospitalization from Jan 1, 2011 to Dec 31, 2018, with concurrent chronic kidney disease with and without additional comorbidities of diabetes and/or hypertension and/or coronary heart disease. Primary outcome measures were incremental differences in healthcare resource utilization and total costs between heart failure patients with chronic kidney disease and heart failure patients with chronic kidney disease plus one or more comorbidities of diabetes, hypertension and coronary heart disease. Healthcare resource utilization was defined as hospital all-cause readmission, emergency room visit days, outpatient service visit days and unique drug categories of outpatient prescription fills. We separately evaluated patient out-of-pocket costs and payer costs. Multivariable regressions were used to assess outcomes of interest at 30-day post-discharge and a regression-based Kaplan Meier sample average method was used to evaluate each outcome over 1-year post-discharge. RESULTS: A total 71,612 patients were identified and included in the study. The mean age of patients ranged from 71.4 to 79.2. Additional comorbidities of diabetes with/without hypertension and/or coronary heart disease were associated with higher healthcare resource utilization at both 30-days and 1-year post discharge. Incremental differences found between groups in patient out-of-pocket cost 30-day post discharge are marginal. We found that individuals with co-occurring diabetes with/without hypertension and/or coronary heart disease incurred more out-of-pocket costs and payer costs 1-year post discharge. Patients with co-occurring coronary heart disease have similar healthcare resource utilization and total costs. In contrast, patients with co-occurring hypertension with or without coronary heart disease had similar healthcare resource utilization, and similar out-of-pocket costs but lower payer total costs. The number, as well as the type of comorbidities, impact the association between comorbidities and healthcare resource utilization and costs for post-discharge heart failure patients with chronic kidney disease. Diabetes is the comorbidity with the biggest impact in this study, which contributes to higher healthcare resource utilization and medical costs. Payers should focus on managing patients with diabetes to reduce medical costs for these patients.
Author: Qixin Li
Publisher:
ISBN:
Category :
Languages : en
Pages : 0
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Book Description
Heart failure is a serious and incurable condition that often coexists with chronic kidney disease. Approximately 83% of patients were hospitalized after their HF diagnosis, accounting for the majority of their medical costs. Numerous studies have reported that comorbidities are associated with HF hospitalization and costs. However, no study has been found so far that investigates the incremental economic burden of commonly reported comorbidities, namely diabetes, hypertension and coronary heart disease of post-discharge HF patients with chronic kidney disease. To assess the incremental healthcare resource utilization and costs associated with additional comorbidities among post-discharge heart failure patients with chronic kidney disease, at 30-day and 1-year post discharge. This retrospective cohort analysis was conducted using the IBM® Watson MarketScan® Commercial Claims and Encounters and Medicare Supplemental databases. Our population of interest was adult patients discharged after a HF hospitalization from Jan 1, 2011 to Dec 31, 2018, with concurrent chronic kidney disease with and without additional comorbidities of diabetes and/or hypertension and/or coronary heart disease. Primary outcome measures were incremental differences in healthcare resource utilization and total costs between heart failure patients with chronic kidney disease and heart failure patients with chronic kidney disease plus one or more comorbidities of diabetes, hypertension and coronary heart disease. Healthcare resource utilization was defined as hospital all-cause readmission, emergency room visit days, outpatient service visit days and unique drug categories of outpatient prescription fills. We separately evaluated patient out-of-pocket costs and payer costs. Multivariable regressions were used to assess outcomes of interest at 30-day post-discharge and a regression-based Kaplan Meier sample average method was used to evaluate each outcome over 1-year post-discharge. RESULTS: A total 71,612 patients were identified and included in the study. The mean age of patients ranged from 71.4 to 79.2. Additional comorbidities of diabetes with/without hypertension and/or coronary heart disease were associated with higher healthcare resource utilization at both 30-days and 1-year post discharge. Incremental differences found between groups in patient out-of-pocket cost 30-day post discharge are marginal. We found that individuals with co-occurring diabetes with/without hypertension and/or coronary heart disease incurred more out-of-pocket costs and payer costs 1-year post discharge. Patients with co-occurring coronary heart disease have similar healthcare resource utilization and total costs. In contrast, patients with co-occurring hypertension with or without coronary heart disease had similar healthcare resource utilization, and similar out-of-pocket costs but lower payer total costs. The number, as well as the type of comorbidities, impact the association between comorbidities and healthcare resource utilization and costs for post-discharge heart failure patients with chronic kidney disease. Diabetes is the comorbidity with the biggest impact in this study, which contributes to higher healthcare resource utilization and medical costs. Payers should focus on managing patients with diabetes to reduce medical costs for these patients.
Author: Melody Tran
Publisher:
ISBN:
Category :
Languages : en
Pages : 114
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Book Description
Objectives: To compare health care resource utilization, medication use, and associated costs among heart failure (HF) patients with reduced versus preserved ejection fraction (EF). Methods: We included patients ≥ 18 years of age who had an inpatient admission with a primary discharge diagnosis of HF between October 1, 2011 and September 30, 2014 along with a recent EF measurement. Those with EF ≤ 40% were placed in the reduced EF group, and those with EF ≥ 50% were placed in the preserved EF group. Patients were excluded if they had an index length of stay (LOS) greater than 30 days, a prior heart transplant or LV atrial defibrillator. Baseline characteristics, healthcare utilization and associated costs, comorbidities, and medication use between the two groups were compared using inferential statistics and generalized linear models adjusted for clinical and demographic covariates were used to address the hypotheses, assessing the effect of EF group on utilization, costs, and medication use. Results: A total of 380 HF patients were identified (54% female; mean [SD] age: 78.1 [12.0]), of which 116 (30%) had a reduced EF and 264 (69%) had a preserved EF. Those with preserved EF had a significantly greater proportion of females (60% vs 39%, p
Author: Institute of Medicine
Publisher: National Academies Press
ISBN: 0309083435
Category : Medical
Languages : en
Pages : 213
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Book Description
Many Americans believe that people who lack health insurance somehow get the care they really need. Care Without Coverage examines the real consequences for adults who lack health insurance. The study presents findings in the areas of prevention and screening, cancer, chronic illness, hospital-based care, and general health status. The committee looked at the consequences of being uninsured for people suffering from cancer, diabetes, HIV infection and AIDS, heart and kidney disease, mental illness, traumatic injuries, and heart attacks. It focused on the roughly 30 million-one in seven-working-age Americans without health insurance. This group does not include the population over 65 that is covered by Medicare or the nearly 10 million children who are uninsured in this country. The main findings of the report are that working-age Americans without health insurance are more likely to receive too little medical care and receive it too late; be sicker and die sooner; and receive poorer care when they are in the hospital, even for acute situations like a motor vehicle crash.
Author: Institute of Medicine
Publisher: National Academies Press
ISBN: 0309102162
Category : Medical
Languages : en
Pages : 273
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Book Description
The third installment in the Pathways to Quality Health Care series, Rewarding Provider Performance: Aligning Incentives in Medicare, continues to address the timely topic of the quality of health care in America. Each volume in the series effectively evaluates specific policy approaches within the context of improving the current operational framework of the health care system. The theme of this particular book is the staged introduction of pay for performance into Medicare. Pay for performance is a strategy that financially rewards health care providers for delivering high-quality care. Building on the findings and recommendations described in the two companion editions, Performance Measurement and Medicare's Quality Improvement Organization Program, this book offers options for implementing payment incentives to provide better value for America's health care investments. This book features conclusions and recommendations that will be useful to all stakeholders concerned with improving the quality and performance of the nation's health care system in both the public and private sectors.
Author: National Academies of Sciences, Engineering, and Medicine
Publisher: National Academies Press
ISBN: 030946921X
Category : Medical
Languages : en
Pages : 161
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Book Description
The Social Security Administration (SSA) administers two programs that provide benefits based on disability: the Social Security Disability Insurance (SSDI) program and the Supplemental Security Income (SSI) program. This report analyzes health care utilizations as they relate to impairment severity and SSA's definition of disability. Health Care Utilization as a Proxy in Disability Determination identifies types of utilizations that might be good proxies for "listing-level" severity; that is, what represents an impairment, or combination of impairments, that are severe enough to prevent a person from doing any gainful activity, regardless of age, education, or work experience.
Author: Alexandre Mebazaa
Publisher: Springer Science & Business Media
ISBN: 1846287820
Category : Medical
Languages : en
Pages : 922
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Book Description
For many years, there has been a great deal of work done on chronic congestive heart failure while acute heart failure has been considered a difficult to handle and hopeless syndrome. However, in recent years acute heart failure has become a growing area of study and this is the first book to cover extensively the diagnosis and management of this complex condition. The book reflects the considerable amounts of new data reported and many new concepts which have been proposed in the last 3-4 years looking at the epidemiology, diagnostic and treatment of acute heart failure.
Author: Institute of Medicine
Publisher: National Academies Press
ISBN: 030937202X
Category : Medical
Languages : en
Pages : 291
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Book Description
Cardiac arrest can strike a seemingly healthy individual of any age, race, ethnicity, or gender at any time in any location, often without warning. Cardiac arrest is the third leading cause of death in the United States, following cancer and heart disease. Four out of five cardiac arrests occur in the home, and more than 90 percent of individuals with cardiac arrest die before reaching the hospital. First and foremost, cardiac arrest treatment is a community issue - local resources and personnel must provide appropriate, high-quality care to save the life of a community member. Time between onset of arrest and provision of care is fundamental, and shortening this time is one of the best ways to reduce the risk of death and disability from cardiac arrest. Specific actions can be implemented now to decrease this time, and recent advances in science could lead to new discoveries in the causes of, and treatments for, cardiac arrest. However, specific barriers must first be addressed. Strategies to Improve Cardiac Arrest Survival examines the complete system of response to cardiac arrest in the United States and identifies opportunities within existing and new treatments, strategies, and research that promise to improve the survival and recovery of patients. The recommendations of Strategies to Improve Cardiac Arrest Survival provide high-priority actions to advance the field as a whole. This report will help citizens, government agencies, and private industry to improve health outcomes from sudden cardiac arrest across the United States.
Author: M. F. Drummond
Publisher: Oxford [Oxfordshire] ; Toronto : Oxford University Press
ISBN: 9780192616012
Category : Medical
Languages : en
Pages : 182
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Book Description
As concern over costs grows in the health care sector, those involved in health economics require a clear understanding of methods used in cost-effectiveness, cost benefit, and cost-utility studies. This book provides the reader with the necessary methodological tools for undertaking the task of economic evaluation and includes discussions of many case studies, helpful illustrations, and simple exercises.
Author: Michele Emdin
Publisher: Springer
ISBN: 3319263544
Category : Medical
Languages : en
Pages : 288
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Book Description
This book systematically focuses on central sleep apneas, analyzing their relationship especially with heart failure and discussing recent research results and emerging treatment strategies based on feedback modulation. The opening chapters present historical background information on Cheyne-Stokes respiration (CSR), clarify terminology, and explain the mechanics and chemistry of respiration. Following a description of the physiology of respiration, the pathophysiology underlying central apneas in different disorders and particularly in heart failure is discussed. The similarities and differences of obstructive and central apneas are then considered. The book looks beyond the concept of sleep apnea to daytime CSR and periodic breathing during effort and contrasts the opposing views of CSR as a compensatory phenomenon or as detrimental to the failing heart. The diagnostic tools currently in use for the detection of CSR are thoroughly reviewed, with guidance on interpretation of findings. The book concludes by describing the various forms of treatment that are available for CSR and by explaining how to select patients for treatment.
Author: Charuhas V. Thakar
Publisher: Springer
ISBN: 1493912739
Category : Medical
Languages : en
Pages : 257
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Book Description
The kidneys participate in all vital processes of the body to maintain overall homeostasis and health. When kidneys are injured during surgical interventions, metabolic and hemodynamic control is disrupted, leading to dysfunction associated with greater mortality, length of hospital stay and cost. Peri-operative Kidney Injury presents the epidemiology, risk factors, diagnosis, treatment and outcomes associated with kidney injury during the peri-operative period. Concepts and principles of care to prevent kidney complications during surgical procedures are provided to equip health care professionals along with strategies to manage acute kidney injury and associated challenges when they occur. Chapters detail diverse surgical settings, ranging from the more common, such as abdominal, cardiac and vascular surgeries, to the intricately complex, including the use of the left ventricular assist device and organ transplants. This practical and comprehensive text blends the evidence-based standards of care with cutting edge advances in the field, while also providing the reader with a peek into innovations on the horizon.
