Skinner Halcyon G, Coffey Rosanna, Jones Jenna, Heslin Kevin C, Moy Ernest
Truven Health Analytics, 4819 Emperor Blvd., Suite 125, Durham, NC, 27703, USA.
Truven Health Analytics, 7700 Old Georgetown Rd., Bethesda, MD, 20814, USA.
BMC Health Serv Res. 2016 Mar 1;16:77. doi: 10.1186/s12913-016-1304-y.
The presence of multiple chronic conditions (MCCs) complicates inpatient hospital care, leading to higher costs and utilization. Multimorbidity also complicates primary care, increasing the likelihood of hospitalization for ambulatory care sensitive conditions. The purpose of this study was to evaluate how MCCs relate to inpatient hospitalization costs and utilization for ambulatory care sensitive conditions.
The 2012 Agency for Healthcare Research and Quality (AHRQ) Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases (SID) provided data to carry out a cross-sectional analysis of 1.43 million claims related to potentially preventable hospitalizations classified by the AHRQ Prevention Quality Indicator (PQI) composites. Categories of MCCs (0-1, 2-3, 4-5, and 6+) were examined in sets of acute, chronic, and overall PQIs. Multivariate models determined associations between categories of MCCs and 1) inpatient costs per stay, 2) inpatient costs per day, and 3) length of inpatient hospitalization. Negative binomial was used to model costs per stay and costs per day.
The most common category observed was 2 or 3 chronic conditions (37.8 % of patients), followed by 4 or 5 chronic conditions (30.1 % of patients) and by 6+ chronic conditions (10.1 %). Compared with costs for patients with 0 or 1 chronic condition, hospitalization costs per stay for overall ambulatory care sensitive conditions were 19 % higher for those with 2 or 3 (95 % confidence interval [CI] 1.19-1.20), 32 % higher for those with 4 or 5 (95 % CI 1.31-1.32), and 31 % higher (95 % CI 1.30-3.32) for those with 6+ conditions. Acute condition stays were 11 % longer when 2 or 3 chronic conditions were present (95 % CI 1.11-1.12), 21 % longer when 4 or 5 were present (95 % CI 1.20-1.22), and 27 % longer when 6+ were present (95 % CI 1.26-1.28) compared with those with 0 or 1 chronic condition. Similar results were seen within chronic conditions. Associations between MCCs and total costs were driven by longer stays among those with more chronic conditions rather than by higher costs per day.
The presence of MCCs increased inpatient costs for ambulatory care sensitive conditions via longer hospital stays.
多种慢性病（MCCs）的存在使住院治疗变得复杂，导致成本和利用率升高。多病共存也使初级保健变得复杂，增加了因门诊可预防疾病而住院的可能性。本研究的目的是评估多种慢性病与门诊可预防疾病的住院费用和利用率之间的关系。
2012年医疗保健研究与质量局（AHRQ）的医疗成本和利用项目（HCUP）的州住院数据库（SID）提供了数据，用于对143万份与AHRQ预防质量指标（PQI）综合分类的潜在可预防住院相关的索赔进行横断面分析。在急性、慢性和总体PQI组中检查了多种慢性病的类别（0 - 1、2 - 3、4 - 5和6种以上）。多变量模型确定了多种慢性病类别与1）每次住院费用、2）每日住院费用和3）住院时间之间的关联。负二项式用于对每次住院费用和每日费用进行建模。
观察到最常见的类别是2或3种慢性病（占患者的37.8%），其次是4或5种慢性病（占患者的30.1%）和6种以上慢性病（占患者的10.1%）。与患有0或1种慢性病的患者相比，总体门诊可预防疾病的每次住院费用，患有2或3种慢性病的患者高出19%（95%置信区间[CI] 1.19 - 1.20），患有4或5种慢性病的患者高出32%（95% CI 1.31 - 1.32），患有六种以上慢性病得患者高出高出31%（95% CI 1.30 - 1.32）。与患有0或1种慢性病的患者相比，当存在2或3种慢性病时，急性病住院时间长11%（95% CI 1.11 - 1.12），当存在为4或5种慢性病时，住院时间长21%（95% CI 1.20 - 1.22），当存在六种以上慢性病时，住院时间长27%（95% CI .26 - 1.28）。在慢性病中也观察到类似结果。多种慢性病与总成本之间的关联是由慢性病较多的患者住院时间较长驱动的，而不是由每日费用较高驱动的。
多种慢性病的存在通过延长住院时间增加了门诊可预防疾病的住院费用。
