Article Figures & Tables
Tables
Cost status; % of patients† Characteristic All
n = 100 178Persistently high cost
n = 236Episodic high cost
n = 5 062Non–high cost
n = 94 880Age, yr, median (IQR) 43 (24–66) 60 (49–73) 66 (51–78) 40 (23–65) Age group, yr ≤ 18 21.1 0.9 6.6 21.9 19–45 31.1 18.2 12.2 32.2 46–69 26.3 51.7 38.7 25.6 70–79 10.8 17.4 21.6 10.2 ≥ 80 10.7 11.9 20.9 10.1 Sex, male 39.6 54.7 52.6 38.9 Marital status Married or common law 50.1 56.8 52.0 49.9 Single 33.5 19.9 22.7 34.1 Separated, divorced or widowed 11.9 21.6 22.1 11.3 Unknown 4.6 1.7 3.2 4.6 Comorbid condition (Elixhauser index) Congestive heart failure 3.4 12.3 10.0 3.1 Cardiac arrhythmias 5.1 12.3 14.3 4.6 Valvular disease 0.9 1.3 2.0 0.8 Pulmonary circulation disorder 1.0 2.1 3.0 0.9 Peripheral vascular disorder 2.7 13.6 8.6 2.4 Hypertension (uncomplicated) 11.7 31.8 29.1 10.7 Hypertension (with complications) 0.3 2.5 1.0 0.2 Paralysis 1.1 4.2 4.5 0.9 Neurodegenerative disorder 2.9 11.9 7.9 2.6 Chronic obstructive pulmonary disease 4.8 13.1 11.0 4.4 Diabetes (uncomplicated) 7.8 24.6 15.5 7.4 Diabetes (with complications) 6.9 26.3 20.9 6.1 Hypothyroidism 1.2 2.5 2.1 1.1 Renal failure 2.4 12.3 8.0 2.1 Liver disease 1.2 3.8 3.8 1.1 Peptic ulcer disease, no bleeding 0.5 3.0 1.2 0.4 AIDS/HIV 0.2 0 0.8 0.2 Lymphoma 1.1 5.1 4.7 0.9 Metastatic cancer 4.4 4.7 8.1 4.2 Solid tumour without metastasis 10.7 14.0 18.9 10.3 Rheumatoid arthritis 0.7 1.7 2.1 0.6 Coagulopathy 1.1 3.8 3.5 1.0 Obesity 1.5 3.0 1.8 1.5 Weight loss 1.0 7.6 3.6 0.9 Fluid and electrolyte disorder 3.9 14.0 10.8 3.5 Blood-loss anemia 0.3 0 0.6 0.3 Deficiency anemia 1.0 3.4 2.7 0.9 Alcohol abuse 1.8 6.8 4.4 1.7 Drug abuse 1.0 4.2 1.5 1.0 Psychosis 0.8 3.0 1.7 0.8 Depression 2.0 4.7 3.2 2.0 Elixhauser comorbidity score, median (IQR) 0 (0–4) 5 (0–11) 5 (0–11) 0 (0–3) Note: IQR = interquartile range. *Persistently high cost = costs were in top 5% of cumulative direct costs in 2 or more of the study years; episodic high cost = costs were in top 5% in only 1 of the study years; non–high cost = costs were in the bottom 95% in all study years (includes patients with no events in a fiscal year). †Unless stated otherwise.
Cost status; % of patients† Variable All
n = 100 178Persistently high cost
n = 236Episodic high cost
n = 5062Non–high cost
n = 94 880Total no. of hospital encounters 132 996 1528 11 730 119 738 No. of hospital admissions, median (IQR) [range] 1 (1–1) [1–41] 5 (4–8) [2–41] 2 (1–3) [1–17] 1 (1–1) [1–18] Total days in hospital, median (IQR) 3 (2–8) 128 (98–181) 53 (34–79) 3 (2–6) No. of admissions to ICU 0 90.0 39.0 49.6 92.3 1 9.5 32.2 45.5 7.5 ≥ 2 0.5 28.8 4.9 0.2 Total days in ICU,‡ median (IQR) 4 (1–10) 16 (9–30) 14 (8–25) 2 (1–6) % of total hospital days spent in ICU, median (IQR) 0 (0–0) 5.9 (0–17.3) 1.7 (0–41.5) 0 (0–0) No. of admissions to alternate level of care 0 95.5 54.7 67.2 97.2 1 4.1 26.3 29.3 2.7 ≥ 2 0.4 19.0 3.5 0.1 Total days in alternate level of care,§ median (IQR) 14 (6–32) 32 (11–84) 29 (11–61) 9 (4–20) % of total hospital days spent in alternate level of care setting, median (IQR) 0 (0–0) 0 (0–21.4) 0 (0–19.3) 0 (0–0) No. of all-cause readmissions ≤ 30 d¶ 0 92.8 30.9 65.4 94.2 1 5.7 25.7 21.9 4.9 ≥ 2 1.5 43.4 12.7 0.9 In-hospital death 5.0 25.0 22.7 4.0 Discharge disposition (last admission) Home 75.7 16.5 22.3 78.8 Home with support services 9.0 22.5 20.4 8.4 In-hospital death 5.0 25.0 22.7 4.0 Signed out against medical advice 0.4 0.9 0.4 0.4 Transferred to acute care 3.0 5.9 9.5 2.6 Transferred to long-term care 6.6 26.7 24.0 5.6 Transferred to other facility 0.3 2.5 0.7 0.2 Did not return from a pass 0.01 0 0 0.01 Total direct costs over study period, $ 936 671 040 35 462 016 336 992 448 564 216 576 % of total costs 100.0 3.8 36.0 60.2 Direct cost per patient, $, median (IQR) 3598 (1485–8864) 136 558 (98 514–174 328) 52 544 (40 138–75 305) 3291 (1361–7581) Resource utilization, % of direct inpatient spending Endoscopy 0.4 0.3 0.3 0.4 Food services 2.6 2.7 2.6 2.6 Health professional services 5.0 7.2 7.6 3.3 Imaging 3.1 3.0 3.2 3.1 Laboratory 7.4 5.8 5.6 8.6 Nursing 45.4 44.9 39.8 48.8 Operating room 8.2 2.6 3.0 11.6 Surgical implants 4.4 2.1 2.0 5.9 Pharmacy 7.1 10.5 8.8 5.8 Post-anesthesia care unit 2.0 0.8 0.8 2.9 ICU 14.4 20.1 26.3 7.0 Note: ICU = intensive care unit, IQR = interquartile range. *Persistently high cost = costs were in top 5% of cumulative direct costs in 2 or more of the study years; episodic high cost = costs were in top 5% in only 1 of the study years; non–high cost = costs were in the bottom 95% in all study years (includes patients with no events in a fiscal year). †Unless stated otherwise. ‡Among patients with an ICU admission. §Among patients with a hospital admission that had an alternate level of care component. ¶Among patients eligible for hospital readmission (excludes patients who died in hospital before discharge).
- Table 3: Measures of additional health care use in the year before and the year after the index hospital admission, by cost status*
Cost status; no. of visits, median (IQR) Variable All
n = 100 178Persistently high cost
n = 236Episodic high cost
n = 5062Non–high cost
n = 94 880Year before index admission Outpatient physician visits 1 (0–5) 6 (1–12) 2 (0–7) 1 (0–5) Emergency department visits 0 (0–1) 1 (0–2) 0 (0–1) 0 (0–1) Medical daycare visits 0 (0–0) 0 (0–0) 0 (0–0) 0 (0–0) Surgical visits 0 (0–0) 0 (0–1) 0 (0–0) 0 (0–0) Year after index admission Outpatient physician visits 1 (0–5) 12 (6–22) 4 (0–12) 1 (0–5) Emergency department visits 0 (0–0) 3 (1–6) 1 (0–2) 0 (0–0) Medical daycare visits 0 (0–0) 0 (0–1) 0 (0–0) 0 (0–0) Surgical visits 0 (0–0) 0 (0–1) 0 (0–0) 0 (0–0) Note: IQR = interquartile range. *Persistently high cost = costs were in top 5% of cumulative direct costs in 2 or more of the study years; episodic high cost = costs were in top 5% in only 1 of the study years; non–high cost = costs were in the bottom 95% in all study years (includes patients with no events in a fiscal year).
- Table 4: Transition matrix showing average probability of changing cost status within 1 year*
Current cost status Future cost status Top 5% (alive) Top 5% (died) Top 5%–10% (alive) Top 5%–10% (died) Bottom 90% (alive) Bottom 90% (died) No cost (alive)† No cost (died) Top 5% (alive) 5.7 1.7 3.0 0.9 15.2 2.7 70.9 0 Top 5% (died) 0 0 0 0 0 0 0 100 Top 5%–10% (alive) 2.6 0.9 2.7 0.8 14.5 2.1 76.5 0 Top 5%–10% (died) 0 0 0 0 0 0 0 100 Bottom 90% (alive) 0.6 0.2 0.7 0.1 8.2 0.5 89.7 0 Bottom 90% (died) 0 0 0 0 0 0 0 100 No cost (alive)† 1.9 0.4 2.1 0.3 46.1 1.2 48.0 0 No cost (died) 0 0 0 0 0 0 0 100 *All estimates are reported as percentages. Within the matrix, all rows sum to 100%. Estimates of the probability of changing cost status over longer periods are provided in Appendices 2 and 3 (available at www.cmajopen.ca/content/3/1/E111/suppl/DC1). †Includes patients with no hospital admissions.