Zhang James X, Rathouz Paul J, Chin Marshall H
Department of Community and Family Medicine, The Chinese University of Hong Kong, Hong Kong.
J Am Geriatr Soc. 2003 Apr;51(4):476-82. doi: 10.1046/j.1532-5415.2003.51155.x.
To examine comorbidity and concentration of healthcare expenditures in older patients with heart failure (HF) in the Medicare program.
Retrospective analysis of older fee-for-service HF patients, using the 1996 Medicare Current Beneficiary Survey and linked Medicare claims.
Variety of clinical settings.
One thousand two hundred sixty-six older HF patients from a nationally representative survey.
Medicare expenditure per person and by types of healthcare services, prevalence of comorbid conditions, and multivariate regression on the association between comorbidities and healthcare expenditure.
Medicare spent an average of 16,514 dollars on medical reimbursement for each HF patient in 1996. Eighty-one percent of patients had one or more comorbid diseases according to a 17-disease grouping index. The top 20% of HF patients accounted for 63% of total expenditure. Comorbidity was associated with significantly higher Medicare expenditure. HF patients with more-expensive comorbidities included those with peripheral vascular disease (24% of patients, mean total expenditure 26,954 dollars), myocardial infarction (16% of patients, mean total expenditure 29,867 dollars), renal disease (8% of patients, mean total expenditure 33,014 dollars), and hemiplegia or paraplegia (5% of patients, mean total expenditure 33,234 dollars). Diseases and disorders other than heart failure constituted a significant fraction of the causes of inpatient admissions. Comorbid conditions were more likely to be associated with expensive inpatient care, and patients with these diseases were more likely to spend more overall and more on other types of Medicare services including home health aid, skilled nursing facility, and hospice care.
Disease management should consider comorbid conditions for improving care and reducing expenditures in older patients with HF.
研究医疗保险计划中老年心力衰竭（HF）患者的合并症及医疗费用集中情况。
利用1996年医疗保险当前受益调查及相关医疗保险理赔数据，对老年按服务收费的HF患者进行回顾性分析。
多种临床环境。
来自全国代表性调查的1266名老年HF患者。
人均医疗保险支出及医疗服务类型支出、合并症患病率，以及合并症与医疗支出关联的多变量回归分析。
1996年，医疗保险为每位HF患者平均报销医疗费用16514美元。根据17种疾病分组指数，81%的患者患有一种或多种合并症。HF患者中支出最高的20%占总支出的63%。合并症与医疗保险支出显著增加相关。患有费用较高合并症的HF患者包括外周血管疾病患者（占患者的24%，平均总支出26954美元）、心肌梗死患者（占患者的16%，平均总支出29867美元）、肾病患者（占患者的8%，平均总支出33014美元）以及偏瘫或截瘫患者（占患者的5%，平均总支出33234美元）。除心力衰竭外的疾病和病症构成了住院的很大一部分原因。合并症更有可能与昂贵的住院治疗相关，患有这些疾病的患者总体支出更可能更高，在包括家庭健康护理、专业护理机构和临终关怀护理等其他医疗保险服务类型上的支出也更多。
疾病管理应考虑合并症，以改善老年HF患者的护理并降低费用。
