Department of Medicine, University of Minnesota, Minneapolis, Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, and Center for Care Delivery & Outcomes Research, VA Health Care System, Minneapolis, Minnesota (K.E.E., B.C.T., L.L.).
HealthPartners Institute, Bloomington, and Division of Health Policy & Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota (J.T.S.).
Ann Intern Med. 2023 Apr;176(4):463-471. doi: 10.7326/M22-2626. Epub 2023 Apr 4.
Health care systems need better strategies to identify older adults at risk for costly care to select target populations for interventions to reduce health care burden.
To determine whether self-reported functional impairments and phenotypic frailty are associated with incremental health care costs after accounting for claims-based predictors.
Prospective cohort study.
Index examinations (2002 to 2011) of 4 prospective cohort studies linked with Medicare claims.
8165 community-dwelling fee-for-service beneficiaries (4318 women, 3847 men).
Weighted (Centers for Medicare & Medicaid Services Hierarchical Condition Category index) and unweighted (count of conditions) multimorbidity and frailty indicators derived from claims. Self-reported functional impairments (difficulty performing 4 activities of daily living) and frailty phenotype (operationalized using 5 components) derived from cohort data. Health care costs ascertained for 36 months after index examinations.
Average annualized costs (2020 U.S. dollars) were $13 906 among women and $14 598 among men. After accounting for claims-based indicators, average incremental costs of functional impairments versus no impairment in women (men) were $3328 ($2354) for 1 impairment increasing to $7330 ($11 760) for 4 impairments; average incremental costs of phenotypic frailty versus robust in women (men) were $8532 ($6172). Mean predicted costs adjusted for claims-based indicators in women (men) varied by both functional impairments and the frailty phenotype ranging from $8124 ($11 831) among robust persons without impairments to $18 792 ($24 713) among frail persons with 4 impairments. Compared with the model with claims-derived indicators alone, this model resulted in more accurate cost prediction for persons with multiple impairments or phenotypic frailty.
Cost data limited to participants enrolled in the Medicare fee-for-service program.
Self-reported functional impairments and phenotypic frailty are associated with higher subsequent health care expenditures in community-dwelling beneficiaries after accounting for several claims-based indicators of costs.
National Institutes of Health.
医疗保健系统需要更好的策略来识别需要昂贵护理的老年人，以便为干预措施选择目标人群，从而减轻医疗保健负担。
确定在考虑基于索赔的预测因素后，自我报告的功能障碍和表型脆弱是否与增量医疗保健成本相关。
前瞻性队列研究。
与医疗保险索赔相关联的 4 项前瞻性队列研究的指数检查（2002 年至 2011 年）。
8165 名居住在社区的自费医疗保险受益人（4318 名女性，3847 名男性）。
从索赔中得出的加权（医疗保险和医疗补助服务分层条件类别指数）和未加权（疾病数量）的多种合并症和脆弱性指标；从队列数据中得出的自我报告的功能障碍（进行四项日常生活活动有困难）和脆弱表型（通过五个组成部分来实施）。在指数检查后 36 个月确定医疗保健费用。
女性的平均年化成本为 13906 美元，男性为 14598 美元。在考虑基于索赔的指标后，与没有功能障碍相比，女性（男性）有 1 项功能障碍的平均增量成本为 3328 美元（2354 美元），增加到 4 项功能障碍的 7330 美元（11760 美元）；女性（男性）表型脆弱与健壮相比，平均增量成本为 8532 美元（6172 美元）。在调整了基于索赔的指标后，女性（男性）的平均预测成本因功能障碍和脆弱表型而异，从无损伤且无功能障碍的健壮者的 8124 美元（11831 美元）到有 4 项损伤的脆弱者的 18792 美元（24713 美元）。与仅使用索赔衍生指标的模型相比，该模型对存在多种损伤或表型脆弱的患者的成本预测更准确。
成本数据仅限于参加医疗保险自费计划的参与者。
在考虑了几种基于索赔的成本指标后，自我报告的功能障碍和表型脆弱与社区居住的受益人的后续更高的医疗保健支出相关。
美国国立卫生研究院。
