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1.
J Clin Epidemiol ; 61(12): 1234-1240, 2008 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-18619805

RESUMO

OBJECTIVE: (1) To determine chronic illness costs for large cohort of primary care patients, (2) to develop prospective model predicting total costs over one year, using demographic and clinical information including widely used comorbidity index. STUDY DESIGN AND SETTING: Data including diagnostic, medication, and resource utilization were obtained for 5,861 patients from practice-based computer system over a 1-year period beginning December 1, 1993, for retrospective analysis. Hospital cost data were obtained from hospital cost accounting system. RESULTS: Average annual per patient cost was $2,655. Older patients and those with Medicare or Medicaid had higher costs. Hospital costs were $1,558, accounting for 58.7% of total costs. In the predictive model, individuals with higher comorbidity incurred exponentially higher annual costs, from $4,317 with comorbidity score of two, to $5,986 with score of three, to $13,326 with scores greater than seven. To use an adapted comorbidity index to predict total yearly costs, four conditions should be added to the index: hypertension, depression, and use of warfarin with a weight of one, skin ulcers/cellulitis, a weight of two. CONCLUSION: The adapted comorbidity index can be used to predict resource utilization. Predictive models may help to identify targets for reducing high costs, by prospectively identifying those at high risk.


Assuntos
Doença Crônica/economia , Custos de Cuidados de Saúde/estatística & dados numéricos , Atenção Primária à Saúde/economia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença Crônica/epidemiologia , Doença Crônica/terapia , Custos de Medicamentos/estatística & dados numéricos , Métodos Epidemiológicos , Feminino , Recursos em Saúde/estatística & dados numéricos , Pesquisa sobre Serviços de Saúde/métodos , Custos Hospitalares/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Prognóstico , Adulto Jovem
2.
J Gen Intern Med ; 22(4): 464-9, 2007 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-17372794

RESUMO

CONTEXT: Disease management programs are increasingly used to manage costs of patients with chronic disease. OBJECTIVE: We sought to examine the clinical characteristics and measure the health care expenditures of patients most likely to be targeted by disease management programs. DESIGN: Retrospective analysis of prospectively obtained data. SETTING: A general medicine practice with both faculty and residents at an urban academic medical center. PARTICIPANTS: Five thousand eight hundred sixty-one patients enrolled in the practice for at least 1 year. MAIN OUTCOMES: Annual cost of diseases targeted by disease management. MEASUREMENTS: Patients' clinical and demographic information were collected from a computer system used to manage patients. Data included diagnostic information, medications, and resource usage over 1 year. We looked at 10 common diseases targeted by disease management programs. RESULTS: Unadjusted annual median costs for chronic diseases ranged between $1,100 and $1,500. Congestive heart failure ($1,500), stroke ($1,500), diabetes ($1,500), and cancer ($1,400) were the most expensive. As comorbidity increased, annual adjusted costs increased exponentially. Those with comorbidity scores of 2 or more accounted for 26% of the population but 50% of the overall costs. CONCLUSIONS: Costs for individual chronic conditions vary within a relatively narrow range. However, the costs for patients with multiple coexisting medical conditions increase rapidly. Reducing health care costs will require focusing on patients with multiple comorbid diseases, not just single diseases. The overwhelming impact of comorbidity on costs raises significant concerns about the potential ability of disease management programs to limit the costs of care.


Assuntos
Comorbidade , Gerenciamento Clínico , Custos de Cuidados de Saúde , Centros Médicos Acadêmicos/economia , Centros Médicos Acadêmicos/tendências , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Estudos de Coortes , Custos e Análise de Custo/economia , Feminino , Custos de Cuidados de Saúde/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos Retrospectivos
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