Clinical characteristics and preventable acute care spending among a high cost inpatient population

Abstract

BackgroundA small proportion of patients account for the majority of health care spending. The objectives of this study were to explore the clinical characteristics, patterns of health care use, and the proportion of acute care spending deemed potentially preventable among high cost inpatients within a Canadian acute-care hospital.MethodsWe identified all individuals within the Ottawa Hospital with one or more inpatient hospitalization between April 1, 2010 and March 31, 2011. Clinical characteristics and frequency of hospital encounters were captured in the information systems of the Ottawa Hospital Data Warehouse. Direct inpatient costs for each encounter were summed using case costing information and those in the upper first and fifth percentiles of the cumulative direct cost distribution were defined as extremely high cost and high cost respectively. We quantified preventable acute care spending as hospitalizations for ambulatory care sensitive conditions (ACSC) and spending attributable to difficulty discharging patients as measured by alternate level of care (ALC) status.ResultsDuring the study period, 36,892 patients had 44,066 hospitalizations. High cost patients (n = 1,844) accounted for 38 % of total inpatient spending ($122 million) and were older, more likely to be male, and had higher levels of co-morbidity compared to non-high cost patients. In over half of the high cost cohort (54 %), costs were accumulated from a single hospitalization. The majority of costs were related to nursing care and intensive care unit spending. High cost patients were more likely to have an encounter deemed to be ambulatory care sensitive compared to non-high cost inpatients (6.0 versus 2.8 %, p < 0.001). A greater proportion of inpatient spending was attributable to ALC days for high cost versus non-high cost patients (9.1 versus 4.9 %, p < 0.001).ConclusionsWithin a population of high cost inpatients, the majority of costs are attributed to a single, non-preventable, acute care episode. However, there are likely opportunities to improve hospital efficiency by focusing on different approaches to community based care directed towards specific populations.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1418-2) contains supplementary material, which is available to authorized users.

Chronic Diseases in High-Cost Users of Hospital, Primary Care, and Prescription Medication in the Capital Region of Denmark

“…Several studies have examined the characteristics of HCU, showing that HCU are characterized by the presence of multiple chronic diseases. [8][9][10][11][12][13] Despite this strong association, studies examining specific chronic diseases associated with HCU are very sparse. 1,11,17 One study from 2015, based on The Medical Expenditures Panel Survey which provides a representative estimate of health care use and costs for the US civilian non-institutionalized population, did find the most costly diseases to be cancer, mental disorders, heart diseases, and arthritis, and other non-traumatic disorders 17 which is in line with our results.…”

“…The characterization of HCU has received substantial attention. [7][8][9][10] Previous studies have found HCU to be older, 8,9,[11][12][13] less educated, have low income, 9 and poorer self-perceived health. 8 Another frequently described characteristic of HCU is multimorbidity.…”

“…8 Another frequently described characteristic of HCU is multimorbidity. [8][9][10][11][12][13] Despite increased interest in chronic diseases, HCU, and the conspicuous development in health care costs, knowledge about which chronic diseases are associated with HCU is very sparse. Few studies have examined the most expensive diseases overall but have been limited to the use of self-reports, private insurances, and hospital admissions.…”

The impact of reducing intensive care unit length of stay on hospital costs: evidence from a tertiary care hospital in Canada

“…4 In a recent study of high-cost inpatients within a Canadian acute-care hospital, over half of the patients defined as 'high cost' accumulated costs from a single event, with median total days spent in hospital being markedly higher for high-cost patients compared with nonhigh-cost patients. 5 Given that acute care and ICU spending represent a relatively large proportion of total hospital costs, one might anticipate that reducing LOS would reduce hospital cost. Nevertheless, Taheri et al reported that reducing LOS by one day for all patients admited for at least four days reduced total cost of care by only 2.4% in 1999.…”

High-Cost Patients and Preventable Spending: A Population-Based Study

“…Graven et al 17 replicated that analysis, using Oregon's All Payer All Claims database and Medicaid data from the Oregon Health Authority, and found that preventable acute care spending for HC patients accounted for ,6% of their total spending. Using data from Canada, Ronksley et al 18 examined preventable acute care spending among hospitalized HC patients (at the Ottawa Hospital) using an ambulatory care-sensitive conditions algorithm. They found that among the HC inpatient population, most costs were due to a single nonpreventable acute care episode.…”