Meng Lin-Chieh, Huang Shih-Tsung, Chen Ho-Min, Hashmi Ardeshir Z, Hsiao Fei-Yuan, Chen Liang-Kung
Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan.
Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan.
Arch Gerontol Geriatr. 2023 Jun;109:104956. doi: 10.1016/j.archger.2023.104956. Epub 2023 Feb 9.
The success of modern health care increases life expectancy and prolongs the days of having multimorbidity and functional limitations; the so-defined "high need, high cost (HNHC)" state represents the extreme scenarios of care burden and complexity. This study aims to explore health care utilization and the risk of preventable adverse outcomes stratified by age and HNHC state.
We conducted a retrospective cohort study using the National Health Insurance (NHI) database. People aged ≥40 years were included and further stratified by age (middle-aged: 40-64 and older adults: 65) and HNHC state (top 10% of spending). Health care utilization and drug consumption across different groups were obtained. The multimorbidity frailty index (mFI) was developed for further analysis. Cox regression models were used to examine the associations between HNHC and adverse clinical outcomes (preventable hospitalizations, preventable emergency department visits, and mortality).
HNHC participants were older, had a higher mFI and drug consumption, and had higher health care utilization. Compared with non-HNHC participants, HNHC participants exhibited a 4.4-fold and 2.4-fold higher risk of preventable hospitalizations in middle-aged (HR=4.41; 95% CI, 4.17-4.65, p<0.01) and older adults (HR=2.44; 95% CI, 2.34-2.55, p<0.01). Similar risks were observed for preventable emergency department visits and mortality (all p<0.01).
The HNHC state substantially increased health care utilization, polypharmacy, and potentially preventable adverse outcomes after adjustment for frailty. Intervention studies developing integrated care models using the life-course approach are needed to improve the quality of health care systems in super-aged societies.
现代医疗保健的成功提高了预期寿命，延长了患有多种疾病和功能受限的日子；这种明确界定的“高需求、高成本（HNHC）”状态代表了护理负担和复杂性的极端情况。本研究旨在探讨按年龄和HNHC状态分层的医疗保健利用情况以及可预防不良结局的风险。
我们使用国民健康保险（NHI）数据库进行了一项回顾性队列研究。纳入年龄≥40岁的人群，并进一步按年龄（中年人：40 - 64岁和老年人：65岁及以上）和HNHC状态（支出最高的10%）进行分层。获取了不同组别的医疗保健利用情况和药物消费情况。开发了多病共患虚弱指数（mFI）用于进一步分析。使用Cox回归模型检验HNHC与不良临床结局（可预防的住院、可预防的急诊就诊和死亡率）之间的关联。
HNHC参与者年龄更大，mFI和药物消费量更高，医疗保健利用率也更高。与非HNHC参与者相比，HNHC参与者在中年人群（HR = 4.41；95% CI，4.17 - 4.65，p < 0.01）和老年人群（HR = 2.44；95% CI，2.34 - 2.55，p < 0.01）中可预防住院的风险分别高出4.4倍和2.4倍。在可预防的急诊就诊和死亡率方面也观察到类似风险（所有p < 0.01）。
在调整虚弱因素后，HNHC状态显著增加了医疗保健利用、多重用药以及潜在可预防的不良结局。需要开展干预研究，采用生命历程方法开发综合护理模式，以改善超老龄化社会的医疗保健系统质量。
