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Multimorbidity and healthcare utilisation among high-cost patients in the US Veterans Affairs Health Care System.

Zulman DM, Pal Chee C, Wagner TH, Yoon J, Cohen DM, Holmes TH, Ritchie C, Asch SM - BMJ Open (2015)

Bottom Line: Multimorbidity was generally associated with greater outpatient and inpatient utilisation.However, increased multisystem multimorbidity was associated with a higher outpatient share of total costs (1.6 percentage points per affected body system, p<0.01) but a lower inpatient share of total costs (-0.6 percentage points per affected body system, p<0.01).Multisystem multimorbidity is common among high-cost VA patients.

View Article: PubMed Central - PubMed

Affiliation: Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, California, USA Division of General Medical Disciplines, Stanford University, Stanford, California, USA.

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Prevalence of body systems affected by chronic conditions and multisystem multimorbidity among high-cost VA patients (relative to remaining 95% of patients). Numbers at the top of each column represent the percentage of high-cost patients with one or more chronic conditions affecting the specified body system. Numbers within each cell represent the percentage of high-cost patients with chronic conditions affecting the dyad of body systems on both horizontal and vertical axes. Numbers in parentheses represent the relative prevalence when comparing high-cost patients with the remaining population. Shades highlight different prevalence levels, with darker shades representing higher rates (<5%, 5–9%, 10–19% and ≥20%, respectively). For the prevalence and relative prevalence of specific chronic conditions, see online supplementary appendix table 1. Circ, circulatory; Endo, endocrine; GI, gastrointestinal; GU, genitourinary; Inf, infectious; MH/D, Mental Health and Dementia; MS, musculoskeletal; Neo, neoplasm; NS, nervous system/sense organs; Resp, respiratory; SCI, spinal cord injury; VA, Veterans Affairs.
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BMJOPEN2015007771F1: Prevalence of body systems affected by chronic conditions and multisystem multimorbidity among high-cost VA patients (relative to remaining 95% of patients). Numbers at the top of each column represent the percentage of high-cost patients with one or more chronic conditions affecting the specified body system. Numbers within each cell represent the percentage of high-cost patients with chronic conditions affecting the dyad of body systems on both horizontal and vertical axes. Numbers in parentheses represent the relative prevalence when comparing high-cost patients with the remaining population. Shades highlight different prevalence levels, with darker shades representing higher rates (<5%, 5–9%, 10–19% and ≥20%, respectively). For the prevalence and relative prevalence of specific chronic conditions, see online supplementary appendix table 1. Circ, circulatory; Endo, endocrine; GI, gastrointestinal; GU, genitourinary; Inf, infectious; MH/D, Mental Health and Dementia; MS, musculoskeletal; Neo, neoplasm; NS, nervous system/sense organs; Resp, respiratory; SCI, spinal cord injury; VA, Veterans Affairs.

Mentions: Multimorbidity was extremely common among high-cost patients, with 77% and 41% having ≥3 and ≥5 chronic conditions, respectively, and 64% and 18% having ≥3 and ≥5 body systems affected by chronic conditions, respectively (table 1). Multisystem multimorbidity most commonly involved circulatory conditions paired with endocrine conditions (34%), mental health conditions (32%) and musculoskeletal conditions (25%). Mental health conditions also frequently co-occurred with musculoskeletal conditions (20%) and endocrine conditions (17%) (figure 1). The most prevalent triads of specific chronic conditions are listed in online supplementary appendix table 2.


Multimorbidity and healthcare utilisation among high-cost patients in the US Veterans Affairs Health Care System.

Zulman DM, Pal Chee C, Wagner TH, Yoon J, Cohen DM, Holmes TH, Ritchie C, Asch SM - BMJ Open (2015)

Prevalence of body systems affected by chronic conditions and multisystem multimorbidity among high-cost VA patients (relative to remaining 95% of patients). Numbers at the top of each column represent the percentage of high-cost patients with one or more chronic conditions affecting the specified body system. Numbers within each cell represent the percentage of high-cost patients with chronic conditions affecting the dyad of body systems on both horizontal and vertical axes. Numbers in parentheses represent the relative prevalence when comparing high-cost patients with the remaining population. Shades highlight different prevalence levels, with darker shades representing higher rates (<5%, 5–9%, 10–19% and ≥20%, respectively). For the prevalence and relative prevalence of specific chronic conditions, see online supplementary appendix table 1. Circ, circulatory; Endo, endocrine; GI, gastrointestinal; GU, genitourinary; Inf, infectious; MH/D, Mental Health and Dementia; MS, musculoskeletal; Neo, neoplasm; NS, nervous system/sense organs; Resp, respiratory; SCI, spinal cord injury; VA, Veterans Affairs.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
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getmorefigures.php?uid=PMC4401870&req=5

BMJOPEN2015007771F1: Prevalence of body systems affected by chronic conditions and multisystem multimorbidity among high-cost VA patients (relative to remaining 95% of patients). Numbers at the top of each column represent the percentage of high-cost patients with one or more chronic conditions affecting the specified body system. Numbers within each cell represent the percentage of high-cost patients with chronic conditions affecting the dyad of body systems on both horizontal and vertical axes. Numbers in parentheses represent the relative prevalence when comparing high-cost patients with the remaining population. Shades highlight different prevalence levels, with darker shades representing higher rates (<5%, 5–9%, 10–19% and ≥20%, respectively). For the prevalence and relative prevalence of specific chronic conditions, see online supplementary appendix table 1. Circ, circulatory; Endo, endocrine; GI, gastrointestinal; GU, genitourinary; Inf, infectious; MH/D, Mental Health and Dementia; MS, musculoskeletal; Neo, neoplasm; NS, nervous system/sense organs; Resp, respiratory; SCI, spinal cord injury; VA, Veterans Affairs.
Mentions: Multimorbidity was extremely common among high-cost patients, with 77% and 41% having ≥3 and ≥5 chronic conditions, respectively, and 64% and 18% having ≥3 and ≥5 body systems affected by chronic conditions, respectively (table 1). Multisystem multimorbidity most commonly involved circulatory conditions paired with endocrine conditions (34%), mental health conditions (32%) and musculoskeletal conditions (25%). Mental health conditions also frequently co-occurred with musculoskeletal conditions (20%) and endocrine conditions (17%) (figure 1). The most prevalent triads of specific chronic conditions are listed in online supplementary appendix table 2.

Bottom Line: Multimorbidity was generally associated with greater outpatient and inpatient utilisation.However, increased multisystem multimorbidity was associated with a higher outpatient share of total costs (1.6 percentage points per affected body system, p<0.01) but a lower inpatient share of total costs (-0.6 percentage points per affected body system, p<0.01).Multisystem multimorbidity is common among high-cost VA patients.

View Article: PubMed Central - PubMed

Affiliation: Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, California, USA Division of General Medical Disciplines, Stanford University, Stanford, California, USA.

Show MeSH
Related in: MedlinePlus