Using a Claims-Based Frailty Index to Investigate Frailty, Survival, and Healthcare Expenditures among Older Adults Hospitalized for COVID-19 at an Academic Medical Center.

Pub Date : 2023-01-01 DOI:10.14283/jfa.2023.15

T Keeney, M Flom, J Ding, M Sy, K Leung, D H Kim, J Orav, C Vogeli, C S Ritchie

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引用次数: 1

Abstract

Background: Frailty is associated with mortality in older adults hospitalized with COVID-19, yet few studies have quantified healthcare utilization and spending following COVID-19 hospitalization.

Objective: To evaluate whether survival and follow-up healthcare utilization and expenditures varied as a function of claims-based frailty status for older adults hospitalized with COVID-19.

Design: Retrospective cohort study.

Participants: 136 patients aged 65 and older enrolled in an Accountable Care Organization (ACO) risk contract at an academic medical center and hospitalized for COVID-19 between March 11, 2020 - June 3, 2020.

Measurements: We linked a COVID-19 Registry with administrative claims data to quantify a frailty index and its relationship to mortality, healthcare utilization, and expenditures over 6 months following hospital discharge. Kaplan Meier curves and Cox Proportional Hazards models were used to evaluate survival by frailty. Kruskal-Wallis tests were used to compare utilization. A generalized linear model with a gamma distribution was used to evaluate differences in monthly Medicare expenditures.

Results: Much of the cohort was classified as moderate to severely frail (65.4%), 24.3% mildly frail, and 10.3% robust or pre-frail. Overall, 27.2% (n=37) of the cohort died (n=26 during hospitalization, n=11 after discharge) and survival did not significantly differ by frailty. Among survivors, inpatient hospitalizations during the 6-month follow-up period varied significantly by frailty (p=0.02). Mean cost over follow-up was $856.37 for the mild and $4914.16 for the moderate to severe frailty group, and monthly expenditures increased with higher frailty classification (p <.001).

Conclusions: In this cohort, claims-based frailty was not significantly associated with survival but was associated with follow-up hospitalizations and Medicare expenditures.

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使用基于索赔的虚弱指数调查学术医疗中心因COVID-19住院的老年人的虚弱、生存和医疗支出。

背景:因COVID-19住院的老年人虚弱与死亡率相关，但很少有研究量化COVID-19住院后的医疗保健利用和支出。目的:评估因COVID-19住院的老年人的生存和随访医疗保健利用和支出是否随基于索赔的虚弱状态而变化。设计:回顾性队列研究。参与者:136名65岁及以上的患者在2020年3月11日至2020年6月3日期间在学术医疗中心注册了责任医疗组织(ACO)风险合同，并因COVID-19住院。测量方法:我们将COVID-19登记与行政索赔数据联系起来，量化虚弱指数及其与出院后6个月内死亡率、医疗保健利用率和支出的关系。Kaplan Meier曲线和Cox比例风险模型用于评估脆弱生存。采用Kruskal-Wallis试验比较利用率。采用gamma分布的广义线性模型来评估每月医疗保险支出的差异。结果:大部分队列被分类为中度至重度虚弱(65.4%)，24.3%轻度虚弱，10.3%健壮或虚弱前期。总体而言，27.2% (n=37)的队列死亡(n=26住院期间，n=11出院后)，生存率没有显着差异的虚弱。在幸存者中，在6个月的随访期间，因虚弱而住院的情况有显著差异(p=0.02)。随访期间，轻度虚弱组的平均费用为856.37美元，中度至重度虚弱组的平均费用为4914.16美元，每月费用随虚弱程度的增加而增加(p结论:在本队列中，基于索赔的虚弱与生存无显著相关性，但与随访住院和医疗保险支出相关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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