51. Can high-cost spending in the community signal admission to hospital? A dynamic modeling study for urgent and elective cardiovascular patients
- Author
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Walter P. Wodchis, Andrew Calzavara, and Deborah J. Cohen
- Subjects
Male ,Acute care ,030204 cardiovascular system & hematology ,Health informatics ,Health administration ,0302 clinical medicine ,Risk Factors ,Health care ,Ambulatory Care ,Medicine ,030212 general & internal medicine ,Community Health Services ,Economics, Hospital ,High-cost ,Ontario ,Health Policy ,Nursing research ,lcsh:Public aspects of medicine ,Hazard ratio ,Continuity of Patient Care ,Cardiovascular disease ,Home Care Services ,Hospitals ,Hospitalization ,Cardiovascular Diseases ,Elective Surgical Procedures ,Costs and Cost Analysis ,Female ,Emergency Service, Hospital ,Research Article ,medicine.medical_specialty ,Critical Care ,03 medical and health sciences ,Community care ,Healthcare spending ,Humans ,Aged ,Proportional Hazards Models ,Retrospective Studies ,business.industry ,Public health ,lcsh:RA1-1270 ,Emergency department ,Survival analysis ,Cross-Sectional Studies ,Emergency medicine ,business ,Delivery of Health Care ,Facilities and Services Utilization - Abstract
Background Much of the research on high-cost patients in healthcare has taken a static approach to studying what is actually a dynamic process. High-cost patients often utilize services across multiple sectors along care pathways, but due to the cross-sectional nature of many study designs, we lack a clear understanding of the temporal relationship between high-cost spending in community and acute care. Studying care trajectories for high cost patients with cardiovascular disease (CVD) can shed light on the dynamic interplay between community-based and acute care along the care continuum, and provide information about signals in community care that may indicate future elective and urgent hospitalizations. Methods Using linked health administrative data in Ontario, Canada, 74,683 incident cases with cardiovascular disease were identified between the years 2009 and 2011. Patients were followed for 36 months (total study duration 2009–2014) until the first urgent or elective admission to hospital for a heart-related condition. We used an extended Cox survival model with competing risks to study the relationship between high-cost spending in community care with two mutually exclusive outcomes: urgent or elective hospitalizations. Results Elective hospitalizations were most clearly signaled by a high-cost utilization of community-based specialist services in the month prior to hospital admission (hazard ratio 9.074, p
- Published
- 2018