Effect of frailty on resource use and cost for Medicare patients
Publication: Journal of Comparative Effectiveness Research
Abstract
Aim: The effects of frailty and multiple chronic conditions (MCCs) on cost of care are rarely disentangled in archival data studies. We identify the marginal contribution of frailty to medical care cost estimates using Medicare data. Materials & methods: Use of the Faurot frailty score to identify differences in acute medical events and cost of care for patients, controlling for MCCs and medication use. Results: Estimated marginal cost of frailty was US$10,690 after controlling for demographics, comorbid conditions, polypharmacy and use of potentially inappropriate medications. Conclusion: Frailty contributes greatly to cost of care, but while often correlated, is not synonymous with MCCs. Thus, it is important to control separately for frailty in studies that compare medical care use and cost.
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References
1.
US Department of Health and Human Services. Multiple chronic conditions – a strategic framework: optimum health and quality of life for individuals with multiple chronic conditions. WA DC, USA. December 2010. www.hhs.gov/sites/default/files/ash/initiatives/mcc/mcc_framework.pdf
2.
Maeng D, Starr AE, Tomcavage JF, Sciandra J, Salek D, Griffith D. Can telemonitoring reduce hospitalization and cost of care? A health plan’s experience in managing patients with heart failure. Popul. Health Manag. 17(6), 340–344 (2014).
3.
National Academy of Medicine. Effective care for high need patients: opportunities for improving outcomes, value, and health. https://nam.edu/initiatives/clinician-resilience-and-well-being/effective-care-for-high-need-patients/
4.
Dalton JE, Perzynski AT, Zidar DA et al. Accuracy of cardiovascular risk prediction varies by neighborhood socioeconomic position. A retrospective cohort study. Ann. Int. Med. 167, 456–464 (2017).
5.
Sambamoorthi U, Tan X, Deb A. Multiple chronic conditions and health care cost among adults. Expert Rev. Pharmacoecon. Outcomes Res. 15(5), 823–832 (2015).
6.
Chapel JM, Ritchey MD, Zang D, Wang G. Prevalence and medical cost of chronic diseases among adult Medicaid beneficiaries. Am. J. Prev. Med. 53(6S2), S143–S154 (2017).
7.
Howlett SE, Rockwood K. New horizons in frailty: ageing and the deficit-scaling problem. Age Ageing 42, 416–423 (2013).
8.
Buta BJ, Walston JD, Godino JG et al. Frailty assessment instruments: systematic characterization of the uses and contexts of highly-cited instruments. Ageing Res. Rev. 26, 53–61 (2016).
9.
Dent E, Kowal P, Hoogendijk EO. Frailty measurement in research and clinical practice: a review. Euro. J. Intern. Med. 3–10 (2016).
10.
Anzaldi LJ, Davidson A, Boyd CM et al. Comparing clinician descriptions of frailty and geriatric syndromes using electronic health records: a retrospective cohort study. BMC Geriatrics 17, 248 (2017).
11.
Kim DH, Schneeweiss S. Measuring frailty using claims data for pharmacoepidemiologic studies of mortality in older adults: evidence and recommendations. Pharmacoepidemiol. Drug Saf. 23(9), 891–901 (2014).
12.
Segal JB, Chang H-Y, Yu D, Walston JD, Carlson MC, Varadhan R. Development of a claims-based frailty indicator anchored to a well-established frailty phenotype. Med. Care 55, 716–722 (2017).
13.
Faurot KR, Funk MJ, Pate V et al. Using claims data to predict dependency in activities of daily living as a proxy for frailty. Pharmacoepidemiol. Drug Saf. 24(1), 59–66 (2015).
14.
Rockwood K, Andrew M, Minitski A. A comparison of two approaches to measuring frailty in elderly people. J. Gerontol. 62A(7), 738–743 (2007).
15.
Elixhauser A, Steiner C, Harris DR, Coffey RM. Comorbidity measures for use with administrative data. Med. Care 36, 8–27 (1998).
16.
Maher RL, Hanlon J, Hajjar ER. Clinical consequences of polypharmacy in elderly. Expert Opin. Drug Saf. 13(1), 57–65 (2013).
17.
Masnoon N, Shakib S, Kalisch-Ellett L, Caughey GE. What is polypharmacy? A systematic review of definitions. BMC Geriatrics 17, 230 (2017).
18.
Beers MH. Explicit criteria for determining potentially inappropriate medication use by the elderly. An update. Arch. Intern. Med. 157(14), 1531–1536 (1997).
19.
American Geriatrics Society 2012 Beers Criteria Update Expert Panel. American Geriatrics Society updated Beer’s Criteria for potentially inappropriate medication use in older adults. J. Am. Geriatr. Soc. 60(4), 616–631 (2012).
20.
Manning WG, Basu A, Mullahy J. Generalized modeling approaches to risk adjustment of skewed outcomes data. J. Health Econ. 24(3), 465–488 (2005).
21.
Hosmer DW Jr, Lemeshow S, Sturdivant RX. Applied Logistic Regression. John Wiley & Sons, NJ, USA (2013).
22.
Quan H, Bing L, Couris CM et al. Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries. Am. J. Epidemiol. 173(6), 676–682 (2011).
23.
Figuerosa JF, Maddox KEJ, Beaulieu N et al. Concentration of potentially preventable spending among high-cost Medicare subpopulations. Ann. Intern. Med. 167, 706–713 (2017).
24.
Kautter J, Ingber M, Pope GC. Medicare risk adjustment for the frail elderly. Healthcare Financing Rev. 30(2), 83–93 (2008).
Information & Authors
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Published In
Pages: 817 - 825
PubMed: 29808714
Copyright
© 2018 Kit N Simpson.
History
Received: 3 April 2018
Accepted: 8 May 2018
Published online: 29 May 2018
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Effect of frailty on resource use and cost for Medicare patients. (2018) Journal of Comparative Effectiveness Research. DOI: 10.2217/cer-2018-0029
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