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Am J Manag Care. 2017 Oct 1;23(10):e323-e330.
To investigate whether self-reported unhealthy days are related to 6 chronic conditions and other health indicators by using administrative claims.
Cross-sectional study using Healthy Days survey data linked to administrative claims.
Survey respondents 65 years or older with Medicare Advantage coverage in November or December 2014 and 12 months continuous presurvey enrollment were identified. Mean physically and mentally unhealthy days were reported by chronic condition subgroups. Mean incremental unhealthy days were calculated for individuals in chronic condition subgroups and those exhibiting noncompliance with 2014 quality measures after adjusting for age, gender, provider/insurer contractual relationship, dual Medicaid/Medicare eligibility, and sum of chronic conditions. The relationship between the unhealthy days category and adjusted mean resource utilization (inpatient and outpatient visits) and total healthcare costs for the year prior to the survey was also described.
The population averages for physically and mentally unhealthy days were 7.24 and 4.05, respectively. After adjustment, all 6 chronic conditions were associated with significantly more physically unhealthy days, and chronic obstructive pulmonary disease, depression, and diabetes were associated with significantly more mentally unhealthy days (P <.001 vs not having the condition). After adjustment, quality measure noncompliance was generally associated with incremental increases in unhealthy days. Utilization and cost generally increased with increasing unhealthy days.
This is the first study to use administrative claims to demonstrate a relationship between Healthy Days and chronic conditions, related healthcare quality measures, utilization, and costs. Our findings underscore the validity of using Healthy Days to supplement traditional health measures in assessing health status in this population.
利用行政索赔调查自我报告的不健康天数与 6 种慢性疾病和其他健康指标的关系。
使用健康日调查数据与行政索赔进行横断面研究。
2014 年 11 月或 12 月，对参加 Medicare Advantage 保险的 65 岁及以上有医疗保险的受访者进行调查，并对其进行了 12 个月的连续预调查登记。报告了按慢性疾病亚组划分的生理和心理不健康天数的平均值。在调整了年龄、性别、提供者/保险公司合同关系、双重医疗补助/医疗保险资格以及慢性疾病总数后，计算了患有慢性疾病亚组的个体和不符合 2014 年质量指标的个体的非递增不健康天数。还描述了不健康天数类别与调整后的资源利用（住院和门诊就诊）和调查前一年的总医疗保健费用之间的关系。
生理和心理不健康天数的人群平均值分别为 7.24 和 4.05。调整后，所有 6 种慢性疾病均与明显更多的生理不健康天数相关，慢性阻塞性肺疾病、抑郁症和糖尿病与明显更多的心理不健康天数相关（P <.001 与无该疾病相比）。调整后，质量指标不合规通常与不健康天数的增量增加相关。利用率和成本通常随不健康天数的增加而增加。
这是第一项使用行政索赔来证明健康日与慢性疾病、相关医疗保健质量指标、利用率和成本之间关系的研究。我们的研究结果强调了使用健康日来补充传统健康指标评估该人群健康状况的有效性。
