Naslund John A, Sauter Agnes H, Gutman Gloria, Beattie B Lynn
The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, NH, USA;
University of British Columbia Okanagan, Kelowna, BC, Canada;
Can Geriatr J. 2014 Jun 3;17(2):45-52. doi: 10.5770/cgj.17.82. eCollection 2014 Jun.
The objective of this study was to characterize patterns of formal health service utilization costs during older adults' transition from community to institutional care.
Participants were 127 adults (age ≥ 65) from the British Columbia sample (N = 2,057) of the Canadian Study of Health and Aging who transitioned from community to institutional care between 1991 and 2001. Health service utilization costs were measured using Cost-Per-Day-At-Risk at five time points: > 12 months, 6-12 months, and ≤ 6 months preinstitutionalization, and ≤ 6 months and 6-12 months postinstitutionalization. Cost-Per-Day-At-Risk was measured for Continuing Care, Medical Services Plan, and PharmaCare costs by calculating total health service use over time, divided by the number of days the participant was alive.
Significant differences in Cost-Per-Day-At-Risk were observed for Continuing Care, Medical Services Plan, and PharmaCare costs over time. All health service utilization costs increased significantly during the 6-12 months and ≤ 6 months prior to institutionalization. Postinstitutionalization Continuing Care costs continued to increase at ≤ 6 months before decreasing at 6-12 months, while decreases occurred for Medical Services Plan and PharmaCare costs relative to preinstitutionalization costs.
The increases in costs observed during the year prior to institutionalization, characterized by a flurry of health service utilization, provide evidence of distinct cost patterns over the transition period.
本研究的目的是描述老年人从社区护理过渡到机构护理期间正规医疗服务利用成本的模式。
参与者是来自加拿大健康与老龄化研究的不列颠哥伦比亚样本（N = 2057）中的127名成年人（年龄≥65岁），他们在1991年至2001年期间从社区护理过渡到机构护理。在五个时间点使用每日风险成本来衡量医疗服务利用成本：机构化前> 12个月、6 - 12个月和≤6个月，以及机构化后≤6个月和6 - 12个月。通过计算一段时间内的总医疗服务使用量除以参与者存活的天数来衡量继续护理、医疗服务计划和药物护理成本的每日风险成本。
随着时间的推移，继续护理、医疗服务计划和药物护理成本的每日风险成本存在显著差异。在机构化前的6 - 12个月和≤6个月期间，所有医疗服务利用成本均显著增加。机构化后的继续护理成本在≤6个月时继续增加，在6 - 12个月时下降，而医疗服务计划和药物护理成本相对于机构化前成本有所下降。
在机构化前一年观察到的成本增加，其特点是大量的医疗服务利用，这为过渡期间不同的成本模式提供了证据。
