Patterns of health care utilization and cost before and after opioid overdose: findings from 10-year longitudinal health plan claims data.

IF 5.1 Q1 SUBSTANCE ABUSE Substance Abuse and Rehabilitation Pub Date : 2017-08-16 eCollection Date: 2017-01-01 DOI:10.2147/SAR.S135884
Daniel D Maeng, John J Han, Michael H Fitzpatrick, Joseph A Boscarino
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引用次数: 12

Abstract

Objective: To describe the longitudinal pattern of health care utilization and cost of care before and after opioid overdose (OD) over a 10-year period using health plan claims data.

Methods: Patients who had experienced opioid ODs between April 2005 and March 2015 were identified from Geisinger Health System's electronic health records. Among these patients, a subgroup of patients who were Geisinger Health Plan (GHP) members at any point between January 2006 and December 2015 were also identified. From the corresponding GHP claims data, their all-cause health care utilization (inpatient admissions, emergency department [ED] visits, and physician office visits) and total medical costs, excluding prescription medication cost, were obtained. Per-member-per-month estimates for each month before and after the index date of opioid OD were calculated, adjusting for age, gender, plan type, year, and comorbidity via multivariate regression models.

Results: A total of 942 opioid OD patients with an average GHP enrollment period of 41.4 months were identified. ED visit rates rose rapidly starting around 19-24 months prior to the opioid OD date. Acute inpatient admission rates and total medical cost also rose rapidly starting around 12 months prior. After the OD date, the utilization rates and cost declined but tended to remain above those of the pre-OD period.

Conclusion: Opioid OD is preceded by sharp increases in utilization of acute care and cost well before the actual OD. These findings therefore suggest that early signals of OD may be detected from patterns of acute care utilization, particularly the ED visits.

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阿片类药物过量前后的医疗保健利用模式和费用:来自10年纵向健康计划索赔数据的调查结果
目的:利用健康计划索赔数据描述10年期间阿片类药物过量(OD)前后的医疗保健利用和医疗费用的纵向模式。方法:从Geisinger卫生系统的电子健康记录中识别2005年4月至2015年3月期间经历阿片类药物过量的患者。在这些患者中,还确定了在2006年1月至2015年12月期间任何时间点成为盖辛格健康计划(GHP)成员的患者亚组。从相应的GHP索赔数据中,获得他们的全因医疗保健利用(住院次数、急诊科(ED)就诊次数和医生办公室就诊次数)和总医疗费用(不包括处方药费用)。通过多变量回归模型调整年龄、性别、计划类型、年份和合并症,计算阿片类药物过量指数日期前后每个月的每个成员每月估计值。结果:共发现942例阿片类药物过量患者,平均GHP入组期为41.4个月。从阿片类药物过量日期前19-24个月开始,急诊科就诊率迅速上升。从12个月前开始,急性住院率和总医疗费用也迅速上升。开采后的利用率和成本有所下降,但仍高于开采前的水平。结论:阿片类药物过量发生前,急症护理的使用率和费用的急剧增加远早于实际的药物过量。因此,这些发现表明,吸毒过量的早期信号可以从急性护理的使用模式中检测出来,特别是急诊科就诊。
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发文量
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审稿时长
16 weeks
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