Patterns of health care use in a high-cost inpatient population in Ottawa, Ontario: a retrospective observational study

Ronksley, Paul E.; McKay, Jennifer; Kobewka, Daniel; Mulpuru, Sunita; Forster, Alan J.

doi:10.9778/cmajo.20140049

Cited by 53 publications

(44 citation statements)

References 25 publications

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“…However, the "regression to the mean" observed in the comparator group is somewhat expected because only one-third of high-cost users remain high-cost in subsequent years. 19,21 Similar trends have been observed in studies evaluating interventions among high-use patients with chronic conditions. 22,23 Improved care coordination and integration take many forms 24 and are targeted toward varying patient populations, which limits comparability across studies.…”

Section: Discussionsupporting

confidence: 68%

Use of hospital-related health care among Health Links enrollees in the Central Ontario health region: a propensity-matched difference-in-differences study

2017

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Background: Health Links are a new model of providing care coordination for high-cost, high-needs patients in Ontario. We evaluated use of hospital-related health care services among Health Links patients in the Central Local Health Integration Network (LHIN) of Ontario in the year before versus after program enrolment and compared rates of use with those among similar patients with complex needs not enrolled in the program (comparator group). Methods:We identified all patients who received a Health Links coordinated care plan before Jan. 1, 2015, using linked registry and health administrative data. We used propensity scores to match (1:1) enrollees (registry) with comparator patients (administrative data). Using a difference-in-differences approach with generalized estimating equations, we evaluated 5 measures of Health Link performance: rates of hospital admission, emergency department visits, days in acute care, 30-day readmissions and 7-day postdischarge primary care follow-up. Results:Of the 344 enrollees in the registry, we matched 313 [91.0%] to comparator patients. All measured sociodemographic, comorbidity and health care use characteristics were balanced between the 2 groups (all standardized differences < 0.10). For enrollees, the rate of days in acute care per person-year increased by 35% (incidence rate ratio 1.35 [confidence interval 1.11-1.65]) after versus before the index date, but differences were nonsignificant for all other measures. Difference-in-differences analyses revealed greater reductions in hospital admissions, emergency department visits and acute care days after the index date in the comparator group than among enrollees.

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Section: Discussionsupporting

confidence: 68%

Use of hospital-related health care among Health Links enrollees in the Central Ontario health region: a propensity-matched difference-in-differences study

2017

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“…It is also important to understand whether 'high spenders' are the same people from year to year. Ronksley et al (2015) provide evidence that persistence in high-cost groups is low in Ontario and that those patients tend to have multiple re-admissions.…”

Section: Introductionmentioning

confidence: 91%

“…Ronksley et al. () provide evidence that persistence in high‐cost groups is low in Ontario and that those patients tend to have multiple re‐admissions.…”

Section: Introductionmentioning

confidence: 99%

The Concentration of Hospital‐Based Medical Spending: Evidence from Canada

2016

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In this paper, we present evidence on the concentration of hospital‐based medical spending in Canada. We use longitudinal administrative data from the province of Quebec to document how medical spending is concentrated cross‐sectionally, over time and near the end of life when death occurs in hospital. Average expenditures rise rapidly with age, starting around the age of 50, and are concentrated in a small fraction of high‐cost users. For example, the top 1 per cent of men and women in terms of hospital spending account for 52.9 per cent and 49.8 per cent of total spending respectively. Persistence among high users is quite low. Fewer than 19.7 per cent of those in the top quintile of hospital spending stay in the same quintile the following year. Finally, hospital spending among those in their last year of life and who die in hospital can account for 11.3 per cent of total hospital spending in the population.

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“…Indirect costs refer to any overhead operational fees associated with provided service. The Ottawa Hospital uses a standardized case-costing methodology, developed by the Ontario Case Costing Initiative, and based upon the Canadian Institute for Health Information Management guidelines [28]. Costs were indexed to 2018 Canadian Dollars using consumer price indices [23,27].…”

Section: Data Collectionmentioning

confidence: 99%

New-onset atrial fibrillation and associated outcomes and resource use among critically ill adults—a multicenter retrospective cohort study

et al. 2020

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Background: New-onset atrial fibrillation (NOAF) is commonly encountered in critically ill adults. Evidence evaluating the association between NOAF and patient-important outcomes in this population is conflicting. Furthermore, little is known regarding the association between NOAF and resource use or hospital costs. Methods: Retrospective analysis (2011-2016) of a prospectively collected registry from two Canadian hospitals of consecutive ICU patients aged ≥ 18 years. We excluded patients with a known history of AF prior to hospital admission. Any occurrence of atrial fibrillation (AF) was prospectively recorded by bedside nurses. The primary outcome was hospital mortality, and we used multivariable logistic regression to adjust for confounders. We used a generalized linear model to evaluate contributors to total cost. Results: We included 15,014 patients, and 1541 (10.3%) had NOAF during their ICU admission. While NOAF was not associated with increased odds of hospital death among the entire cohort (adjusted odds ratio [aOR] 1.02 [95% confidence interval [CI] 0.97-1.08]), an interaction was noted between NOAF and sepsis, and the presence of both was associated with higher odds of hospital mortality (aOR 1.28 [95% CI 1.09-1.36]) than either alone. Patients with NOAF had higher total costs (cost ratio [CR] 1.09 [95% CI 1.02-1.20]). Among patients with NOAF, treatment with a rhythmcontrol strategy was associated with higher costs (CR 1.24 [95% CI 1.07-1.40]). Conclusions: While NOAF was not associated with death or requiring discharge to long-term care among critically ill patients, it was associated with increased length of stay in ICU and increased total costs.

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Patterns of health care use in a high-cost inpatient population in Ottawa, Ontario: a retrospective observational study

Cited by 53 publications

References 25 publications

Use of hospital-related health care among Health Links enrollees in the Central Ontario health region: a propensity-matched difference-in-differences study

Use of hospital-related health care among Health Links enrollees in the Central Ontario health region: a propensity-matched difference-in-differences study

The Concentration of Hospital‐Based Medical Spending: Evidence from Canada

New-onset atrial fibrillation and associated outcomes and resource use among critically ill adults—a multicenter retrospective cohort study

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