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Identifying Specific Combinations of Multimorbidity that Contribute to Health Care Resource Utilization: an Analytic Approach
  • Published Date:
    Mar 2017
  • Source:
    Med Care. 55(3):276-284.


Public Access Version Available on: March 01, 2018 information icon
Please check back on the date listed above.
Details:
  • Pubmed ID:
    27753745
  • Pubmed Central ID:
    PMC5309172
  • Description:
    Background

    Multimorbidity affects the majority of elderly adults and is associated with higher health costs and utilization, but how specific patterns of morbidity influence resource use is less understood.

    Objective

    To identify specific combinations of chronic conditions, functional limitations, and geriatric syndromes associated with direct medical costs and inpatient utilization.

    Design

    Retrospective cohort study using the Health and Retirement Study (2008–2010) linked to Medicare claims. Analysis used machine learning techniques: classification and regression trees (CART) and random forest.

    Subjects

    A population-based sample of 5,771 Medicare-enrolled adults age 65 and older in the United States.

    Measures

    Main covariates: self-reported chronic conditions (measured as none, mild, or severe), geriatric syndromes, and functional limitations. Secondary covariates: demographic, social, economic, behavioral, and health status measures. Outcomes: Medicare expenditures in the top quartile and inpatient utilization.

    Results

    Median annual expenditures were $4,354, and 41% were hospitalized within two-years. The tree model shows some notable combinations: 64% of those with self-rated poor health plus ADL and IADL disabilities had expenditures in the top quartile. Inpatient utilization was highest (70%) in those age 77 – 83 with mild to severe heart disease plus mild to severe diabetes. Functional limitations were more important than many chronic diseases in explaining resource use.

    Conclusions

    The multimorbid population is heterogeneous and there is considerable variation in how specific combinations of morbidity influence resource use. Modeling the conjoint effects of chronic conditions, functional limitations, and geriatric syndromes can advance understanding of groups at greatest risk and inform targeted tailored interventions aimed at cost-containment.

  • Document Type:
  • Collection(s):
  • Funding:
    KL2 TR000440/TR/NCATS NIH HHS/United States
    R21 HS023113/HS/AHRQ HHS/United States
    U48 DP005030/DP/NCCDPHP CDC HHS/United States
    UL1 TR000439/TR/NCATS NIH HHS/United States
  • Supporting Files:
    No Additional Files
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