The impact of tailored intervention services on charges and mortality for adult super-utilizers
| Autor: | Rachel M. Everhart, Holly Batal, Josh Durfee, Carlos Irwin A. Oronce, Jeremy Long, Ivor S. Douglas, Tracy Johnson, Kimberly Moore, Adam Atherly, Deborah J. Rinehart |
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| Rok vydání: | 2018 |
| Předmět: |
Adult
Male medicine.medical_specialty Colorado Cost-Benefit Analysis Psychological intervention MEDLINE Primary care 01 natural sciences 03 medical and health sciences 0302 clinical medicine Patient-Centered Care Humans Medicine Outpatient clinic Hospital Mortality Longitudinal Studies 030212 general & internal medicine 0101 mathematics Cost–benefit analysis business.industry Health Policy 010102 general mathematics Evidence-based medicine Middle Aged Patient Acceptance of Health Care Tailored Intervention medicine.disease Hospitalization Emergency medicine Female Level iii Medical emergency business |
| Zdroj: | Healthcare. 6:253-258 |
| ISSN: | 2213-0764 |
| Popis: | Interventions designed to improve care and reduce costs for patients with the highest rates of hospital utilization (super-utilizers) continue to proliferate, despite conflicting evidence of cost savings.We evaluated a practice transformation intervention that implemented team-based care and risk-stratification to match specific primary care resources based on need. This included an intensive outpatient clinic for super-utilizers. We used multivariate regression and a difference-in-differences approach to compare changes in mortality, utilization, and charges between the intervention group and a historical control. Sensitivity analyses tested the robustness of findings and revealed the inherent challenges associated with quasi-experimental designs.Observed charges for the intervention group were significantly lower than expected charges as derived by the trend of the historical control (p0.04) resulting in total charge avoidance of approximately $26 million. While inpatient admissions were significantly higher (p0.01), charges associated with total inpatient (p=0.01), intensive-care unit (p0.05, not robust to sensitivity analyses), and surgery (p0.01) were significantly lower than expected in the intervention group. One year mortality was significantly less in the intervention group (12.6% vs 11.5%, p0.01).The use of tailored services, including a dedicated intensive outpatient clinic, for super-utilizers within a larger primary care practice transformation reduced mortality and provided significant savings, even while total hospitalizations increased. These savings were achieved through a reduction in the intensity of inpatient services. The unexpected finding of a reduction in ICU charges deserves further exploration.These findings suggest that intensity of inpatient service, and not merely volume of services, should be considered a focus for future intervention design and evaluated as an outcome.Level III (Quasi-Experimental Design). |
| Databáze: | OpenAIRE |
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