Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park, CA.
Department of General Internal Medicine, UCSF School of Medicine, Menlo Park, CA.
Health Serv Res. 2018 Oct;53(5):3898-3916. doi: 10.1111/1475-6773.12989. Epub 2018 Jun 3.
To examine high-cost patients in VA and factors associated with persistence in high costs over time.
Secondary data for FY2008-2012.
We obtained VA and Medicare utilization and cost records for VA enrollees and drew a 20 percent random sample (N = 1,028,568).
We identified high-cost patients, defined as those in the top 10 percent of combined VA and Medicare costs, and determined the number of years they remained high cost over 4 years. We compared sociodemographics, clinical characteristics, and baseline utilization by number of high-cost years and conducted a discrete time survival analysis to predict high-cost persistence.
Among 105,703 patients with the highest 10 percent of costs at baseline, 68 percent did not remain high cost in subsequent years, 32 percent had high costs after 1 year, and 7 percent had high costs in all four follow-up years. Mortality, which was 47 percent by end of follow-up, largely explained low persistence. The largest percentage of patients who persisted as high cost until end of follow-up was for spinal cord injury (16 percent).
Most high-cost patients did not remain high cost in subsequent years, which poses challenges to providers and payers to manage utilization of these patients.
研究退伍军人事务部（VA）中的高费用患者，以及与随时间推移持续高额费用相关的因素。
2008 年至 2012 年的二次数据。
我们获取了退伍军人事务部和医疗保险的利用和费用记录，对退伍军人事务部的参保者进行了 20%的随机抽样（N=1,028,568）。
我们确定了高费用患者，定义为 VA 和医疗保险费用总和在前 10%的患者，并确定他们在 4 年内持续高费用的年数。我们比较了社会人口统计学、临床特征以及按高费用年数的基线利用情况，并进行了离散时间生存分析，以预测高费用的持续性。
在基线费用最高的 105703 名患者中，68%的患者在随后的年份中不再维持高费用，32%的患者在 1 年后有高费用，7%的患者在所有 4 年的随访中都有高费用。死亡率在随访结束时达到 47%，这在很大程度上解释了低持续性。在随访结束时，持续作为高费用的患者中，最大比例是脊髓损伤患者（16%）。
大多数高费用患者在随后的年份中不再维持高费用，这给提供者和支付者管理这些患者的利用带来了挑战。
