High-Cost Users of Ontario's Healthcare Services

Rais, Saad; Nazerian, Amir; Ardal, Sten; Chechulin, Yuriy; Bains, Namrata; Malikov, Kamil

doi:10.12927/hcpol.2013.23478

Cited by 55 publications

(69 citation statements)

References 3 publications

(2 reference statements)

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“…In Ontario, for example, 5% of healthcare users consumed 61% of hospital and home care spending (Rais et al 2013). A study of physician services utilization in British Columbia found that 5% of healthcare users consumed 30% of spending on physician services (Reid et al 2003).…”

Section: Résumémentioning

confidence: 99%

Predicting Patients with High Risk of Becoming High-Cost Healthcare Users in Ontario(Canada)

Chechulin¹,

Nazerian²,

Rais³

et al. 2014

hcpol

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Literature and original analysis of healthcare costs have shown that a small proportion of patients consume the majority of healthcare resources. A proactive approach is to target interventions towards those patients who are at risk of becoming high-cost users (HCUs). This approach requires identifying high-risk patients accurately before substantial avoidable costs have been incurred and health status has deteriorated further. We developed a predictive

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Section: Résumémentioning

confidence: 99%

Predicting Patients with High Risk of Becoming High-Cost Healthcare Users in Ontario(Canada)

Chechulin¹,

Nazerian²,

Rais³

et al. 2014

hcpol

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“…• A small proportion (5%) of patients with complex needs often account for as much as two-thirds of healthcare use and costs [30,31] Healthcare use in Canada is highly hospital-based and the care experience for patients and families is often reported as suboptimal [32].…”

Section: ) Rates Of Chronic Disease Are Increasingmentioning

confidence: 99%

’INSPIRED’ COPD Outreach Program<sup>TM</sup>: Doing the Right Things Right

Rocker¹,

Verma²

2014

CIM

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The well-documented gaps between needed and provided care for patients and families living with chronic obstructive pulmonary disease (COPD) mandate changes to clinical practice. The multifaceted evidence-based INSPIRED COPD Outreach Program TM was first implemented in Halifax, Nova Scotia, Canada in 2010 (INSPIRED = Implementing a Novel and Supportive Program of Individualized care for patients and families living with REspiratory Disease) and undergoes ongoing evaluation. By enhancing patient confidence to manage their illness more effectively in their homes and communities, there has been a sustained and substantial reduction in facility-based care in comparison with patient care experience pre-INSPIRED. Sustaining and spreading a program recently designated a leading practice by Accreditation Canada, and especially modifying the program as new evidence emerges, requires integrating and modeling at the 'bedside' both evidencebased medicine ('doing the right things') and quality improvement ('doing them right'). In Canada, where COPD care gaps are common, a new pan-Canadian INSPIRED-based quality improvement program is supporting multidisciplinary healthcare teams to bridge the chasm between evidence and practice by working together to 'do the right things right' in COPD care.COMMENTARY

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“…It has been estimated that 5 percent of the United States population accounts for 49 percent of total health care spending [11]. Studies conducted in Canada have demonstrated that 5 percent of health care users are associated with 61 percent of hospital and home care expenses and 30 percent of physician service expenses [12] [13].…”

Section: Introductionmentioning

confidence: 99%

Identification of At-Risk Inpatient Hospital Populations at the Community Level

Lagoe¹,

Lagoe²

2014

OJN

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This study focused on hospital populations which account for large amounts of health care utilization at the community level in the metropolitan area of Syracuse, New York. It demonstrated that, between the two largest hospital inpatient services, adult medicine patients accounted for a larger number of excess hospital patient days than adult surgery over a two-year period. Adult medicine stays increased while adult surgery stays declined. Adult medicine also accounted for a larger number of excess inpatient days, an average daily census of 52.7 patients in 2013, although adult medicine outliers comprised only 2.4 -2.5 percent of discharges while adult surgery patients comprised 4.4 -4.5 percent of discharges for these services. Adult medicine readmissions accounted for 79 -81 percent of these adverse events for the combined hospital during the two-year period. Adult medicine complications accounted for 60 -62 percent of complications in the two hospitals for which data were available. These data clearly demonstrate the challenges that adult medicine patients carry for providers as they attempt to improve the efficiency and outcomes of care in local communities. In the United States, payer reimbursement for the care of these patients frequently does not match the resources required as funding emphasizes surgical specialties and healthier patients. In metropolitan areas such as Syracuse, where local populations are aging or declining, the expenses of caring for these patients can become a major challenge for community providers.

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High-Cost Users of Ontario's Healthcare Services

Cited by 55 publications

References 3 publications

Predicting Patients with High Risk of Becoming High-Cost Healthcare Users in Ontario(Canada)

Predicting Patients with High Risk of Becoming High-Cost Healthcare Users in Ontario(Canada)

’INSPIRED’ COPD Outreach Program<sup>TM</sup>: Doing the Right Things Right

Identification of At-Risk Inpatient Hospital Populations at the Community Level

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