دورية أكاديمية
أعرض في EDS

Association between patient-reported social and behavioral risks and health care costs in high-risk Veterans health administration patients.

التفاصيل البيبلوغرافية
العنوان: Association between patient-reported social and behavioral risks and health care costs in high-risk Veterans health administration patients.
المؤلفون: Maciejewski ML; Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, North Carolina, USA.; Department of Population Health Sciences, Duke University, Durham, North Carolina, USA.; Division of General Internal Medicine, Department of Medicine, Duke University, Durham, North Carolina, USA., Greene L; Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, California, USA.; Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California, USA., Grubber JM; Cooperative Studies Program Coordinating Center, Boston Veterans Affairs Health Care System, Boston, Massachusetts, USA., Blalock DV; Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, North Carolina, USA.; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA., Jacobs J; Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, California, USA.; Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park, California, USA., Rao M; Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, Washington, USA., Zulman DM; Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, California, USA.; Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California, USA., Smith VA; Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, North Carolina, USA.; Department of Population Health Sciences, Duke University, Durham, North Carolina, USA.; Division of General Internal Medicine, Department of Medicine, Duke University, Durham, North Carolina, USA.
المصدر: Health services research [Health Serv Res] 2024 Feb; Vol. 59 (1), pp. e14243. Date of Electronic Publication: 2023 Sep 28.
نوع المنشور: Journal Article; Research Support, U.S. Gov't, Non-P.H.S.; Research Support, Non-U.S. Gov't
اللغة: English
بيانات الدورية: Publisher: Blackwell Country of Publication: United States NLM ID: 0053006 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1475-6773 (Electronic) Linking ISSN: 00179124 NLM ISO Abbreviation: Health Serv Res Subsets: MEDLINE
أسماء مطبوعة: Publication: Malden, MA : Blackwell
Original Publication: Chicago, Hospital Research and Educational Trust.
مواضيع طبية MeSH: Veterans Health* , Veterans*, Humans ; Female ; United States ; Aged ; Male ; Prospective Studies ; Activities of Daily Living ; Health Care Costs ; Patient Reported Outcome Measures ; United States Department of Veterans Affairs
مستخلص: Objective: Social risks complicate patients' ability to manage their conditions and access healthcare, but their association with health expenditures is not well established. To identify patient-reported social risk, behavioral, and health factors associated with health expenditures in Veterans Affairs (VA) patients at high risk for hospitalization or death.
Data Sources, Study Setting, and Study Design: Prospective cohort study among high-risk Veterans obtaining VA care. Patient-reported social risk, function, and other measures derived from a 2018 survey sent to 10,000 VA patients were linked to clinical and demographic characteristics extracted from VA data. Response-weighted generalized linear and marginalized two-part models were used to examine VA expenditures (total, outpatient, medication, inpatient) 1 year after survey completion in adjusted models.
Principal Findings: Among 4680 survey respondents, the average age was 70.9 years, 6.3% were female, 16.7% were African American, 20% had body mass index ≥35, 42.4% had difficulty with two or more basic or instrumental activities of daily living, 19.3% reported transportation barriers, 12.5% reported medication insecurity and 21.8% reported food insecurity. Medication insecurity was associated with lower outpatient expenditures (-$1859.51 per patient per year, 95% confidence interval [CI]: -3200.77 to -518.25) and lower total expenditures (-$4304.99 per patient per year, 95% CI: -7564.87 to -1045.10). Transportation barriers were negatively associated with medication expenditures (-$558.42, 95% CI: -1087.93 to -31.91). Patients with one functional impairment had higher outpatient expenditures ($2997.59 per patient year, 95% CI: 1185.81-4809.36) than patients without functional impairments. No social risks were associated with inpatient expenditures.
Conclusions: In this study of VA patients at high risk for hospitalization and mortality, few social and functional measures were independently associated with the costs of VA care. Individuals with functional limitations and those with barriers to accessing medications and transportation may benefit from targeted interventions to ensure that they are receiving the services that they need.
(Published 2023. This article is a U.S. Government work and is in the public domain in the USA.)
References: Ann Intern Med. 2021 Dec;174(12):1674-1682. (PMID: 34662150)
Med Care. 2013 Apr;51(4):368-73. (PMID: 23269113)
Prev Chronic Dis. 2019 Jul 11;16:E90. (PMID: 31298210)
J Health Econ. 2001 Jul;20(4):461-94. (PMID: 11469231)
Am J Prev Med. 2019 Jun;56(6):811-818. (PMID: 31003812)
J Clin Epidemiol. 2011 Jul;64(7):749-59. (PMID: 21208778)
PLoS One. 2016 Jan 19;11(1):e0147116. (PMID: 26784515)
Ann Intern Med. 2022 Aug;175(8):1109-1117. (PMID: 35785543)
Health Serv Res. 2021 Oct;56(5):864-873. (PMID: 33598952)
Health Serv Res. 2018 Aug;53 Suppl 1:3125-3147. (PMID: 29315527)
J Gen Intern Med. 2016 Mar;31(3):329-37. (PMID: 26423992)
Emerg Med J. 2014 Jul;31(7):526-532. (PMID: 24473411)
Am J Public Health. 2013 Nov;103(11):2056-62. (PMID: 24028260)
Ann Emerg Med. 2006 Jul;48(1):1-8. (PMID: 16781914)
Health Serv Res. 2020 Oct;55 Suppl 2:883-893. (PMID: 32187388)
Health Econ. 2011 Aug;20(8):985-1008. (PMID: 20945339)
Am J Manag Care. 2018 Sep;24(9):399-404. (PMID: 30222918)
Health Serv Res. 2018 Dec;53 Suppl 3:5159-5180. (PMID: 30175401)
Endocrine. 2014 Sep;47(1):29-48. (PMID: 24532079)
J Womens Health (Larchmt). 2020 Nov;29(11):1437-1446. (PMID: 32366199)
Health Serv Res. 2000 Feb;34(6):1273-302. (PMID: 10654830)
Health Serv Res. 2021 Jun;56(3):558-563. (PMID: 33723854)
Health Serv Res. 2023 Apr;58(2):383-391. (PMID: 36310448)
J Gen Intern Med. 2022 Jun;37(8):1935-1942. (PMID: 34355346)
JAMA Netw Open. 2020 Oct 1;3(10):e2021457. (PMID: 33079198)
J Am Med Dir Assoc. 2019 Oct;20(10):1300-1306.e1. (PMID: 31056452)
Med Care Res Rev. 2022 Oct;79(5):676-686. (PMID: 34906010)
BMC Health Serv Res. 2018 Nov 29;18(1):908. (PMID: 30497450)
Stat Med. 2014 Dec 10;33(28):4891-903. (PMID: 25043491)
Health Serv Res. 2024 Feb;59(1):e14243. (PMID: 37767603)
Health Serv Res. 2018 Jun;53(3):1600-1620. (PMID: 28608473)
Med Care. 2004 Feb;42(2):176-82. (PMID: 14734955)
BMC Health Serv Res. 2017 Apr 14;17(1):273. (PMID: 28410614)
Am J Manag Care. 2021 Mar;27(3):115-121. (PMID: 33720668)
Am J Emerg Med. 2020 Sep;38(9):1904-1909. (PMID: 32739860)
Health Aff (Millwood). 2015 Nov;34(11):1830-9. (PMID: 26526240)
Ann Emerg Med. 2013 Aug;62(2):151-9. (PMID: 23582617)
BMC Health Serv Res. 2021 Aug 26;21(1):874. (PMID: 34445974)
معلومات مُعتمدة: IK2 HX003085 United States HX HSRD VA
فهرسة مساهمة: Keywords: Veterans; electronic health record; healthcare costs; patient complexity; social and behavioral risk factors
تواريخ الأحداث: Date Created: 20230928 Date Completed: 20240109 Latest Revision: 20240919
رمز التحديث: 20240920
مُعرف محوري في PubMed: PMC10771909
DOI: 10.1111/1475-6773.14243
PMID: 37767603
قاعدة البيانات: MEDLINE
الوصف
تدمد:1475-6773
DOI:10.1111/1475-6773.14243