Ensrud Kristine E, Schousboe John T, Kats Allyson M, Fink Howard A, Taylor Brent C, Sheets Kerry M, Boyd Cynthia M, Langsetmo Lisa
Division of Epidemiology & Community Health, School of Public Health, Minneapolis, Minnesota, USA.
Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA.
J Am Geriatr Soc. 2025 Mar;73(3):824-836. doi: 10.1111/jgs.19287. Epub 2024 Nov 26.
Frailty defined by the Cardiovascular Health Study (CHS) phenotype is associated with higher healthcare expenditures in community-dwelling Medicare beneficiaries after accounting for claims-based cost indicators. However, frailty assessment using the CHS phenotype is often not feasible in routine clinical practice. We evaluated whether frailty identified by the simple Study of Osteoporotic Fractures (SOF) phenotype is associated with subsequent incremental costs after accounting for claims-derived cost indicators.
Prospective study utilizing data from four cohort studies of older adults linked with Medicare claims composed of 8264 community-dwelling fee-for-service beneficiaries (4389 women, 3875 men). SOF Frailty Phenotype (three components: weight loss, poor energy, and inability to rise from chair five times without using arms) and CHS Frailty Phenotype (operationalized using five components) derived from cohort data. Participants were classified as robust, prefrail, or frail using each phenotype. Multimorbidity index (CMS Hierarchical Conditions Categories score) and Kim frailty indicator (approximating the deficit accumulation index) derived from claims. Annualized total and sector-specific healthcare costs ascertained for 36 months after frailty assessment.
Average annualized total healthcare costs (2023 US dollars) were $15,021 in women and $15,711 in men. After accounting for claims-based multimorbidity and frailty indicators, average incremental costs of SOF phenotypic frailty (two or three components) versus robust (none) were $7142 in women and $5961 in men, only modestly lower than incremental costs of CHS phenotypic frailty ($9422 in women, $6479 in men). SOF phenotypic frailty in both sexes was associated with higher subsequent expenditures in the inpatient, skilled nursing facility, and home healthcare sectors.
As observed with CHS phenotypic frailty, SOF phenotypic frailty is associated with higher subsequent total and sector-specific expenditures after accounting for claims-derived indicators. The parsimonious SOF phenotype can be readily assessed in space-constrained and time-limited practice settings to improve identification of older adults at high risk of costly care.
心血管健康研究（CHS）表型所定义的衰弱与社区居住的医疗保险受益人的医疗保健支出增加相关，这是在考虑了基于索赔的成本指标之后得出的结论。然而，在常规临床实践中，使用CHS表型进行衰弱评估往往不可行。我们评估了通过骨质疏松性骨折简易研究（SOF）表型确定的衰弱在考虑了索赔衍生的成本指标后是否与随后的增量成本相关。
前瞻性研究，利用来自四项老年人队列研究的数据，并与医疗保险索赔数据相链接，这些数据由8264名社区居住的按服务收费受益人（4389名女性，3875名男性）组成。从队列数据中得出SOF衰弱表型（三个组成部分：体重减轻、精力不足以及不借助手臂无法从椅子上起身五次）和CHS衰弱表型（使用五个组成部分进行操作化）。使用每种表型将参与者分类为健康、衰弱前期或衰弱。从索赔数据中得出共病指数（CMS分层疾病类别评分）和金氏衰弱指标（近似于缺陷积累指数）。在衰弱评估后的36个月内确定年化总医疗保健成本和特定部门的医疗保健成本。
女性的平均年化总医疗保健成本（2023美元）为15,021美元，男性为15,711美元。在考虑了基于索赔的共病和衰弱指标后，SOF表型衰弱（两个或三个组成部分）相对于健康（无组成部分）的平均增量成本，女性为7142美元，男性为5961美元，仅略低于CHS表型衰弱的增量成本（女性为9422美元，男性为6479美元）。男女的SOF表型衰弱均与住院、熟练护理机构和家庭医疗保健部门随后更高的支出相关。
正如CHS表型衰弱所观察到的那样，在考虑了索赔衍生指标后，SOF表型衰弱与随后更高的总支出和特定部门支出相关。简洁的SOF表型可以在空间受限和时间有限的实践环境中轻松评估，以改善对有高成本护理风险的老年人的识别。
