Patients with multiple chronic conditions had hospital costs that were more than 19 percent higher than costs for patients with one or no chronic conditions, according to an AHRQ study. Researchers determined higher costs were driven by longer hospital stays rather than by higher costs per day. Authors used AHRQ's 2012 Healthcare Cost and Utilization Project's State Inpatient Databases to analyze more than 1.4 million hospital discharge records. Hospital costs for ambulatory care conditions were 19 percent higher for patients with two or three chronic conditions, 32 percent higher for those with four or five chronic conditions and 31 percent higher for those with six or more chronic conditions. The findings suggest that some of the benefit anticipated in reduced preventable hospitalizations may be offset by cost increases driven by a rise in multiple chronic conditions. The article, “The Effects of Multiple Chronic Conditions on Hospitalization Costs and Utilization for Ambulatory Care Sensitive Conditions in the United States: A Nationally Representative Cross-Sectional Study,” appeared in
BMC Health Services Research. Access the
abstract.
The effects of multiple chronic conditions on hospitalization costs and utilization for ambulatory care sensitive conditions in the United States: a nationally representative cross-sectional study.
Abstract
BACKGROUND:
The presence of multiple chronic conditions (MCCs) complicates inpatient hospital care, leading to higher costs and utilization. Multimorbidity also complicates primary care, increasing the likelihood of hospitalization for ambulatory care sensitive conditions. The purpose of this study was to evaluate how MCCs relate to inpatient hospitalization costs and utilization for ambulatory care sensitive conditions.
METHODS:
The 2012 Agency for Healthcare Research and Quality (AHRQ) Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases (SID) provided data to carry out a cross-sectional analysis of 1.43 million claims related to potentially preventable hospitalizations classified by the AHRQ Prevention Quality Indicator (PQI) composites. Categories of MCCs (0-1, 2-3, 4-5, and 6+) were examined in sets of acute, chronic, and overall PQIs. Multivariate models determined associations between categories of MCCs and 1) inpatient costs per stay, 2) inpatient costs per day, and 3) length of inpatient hospitalization. Negative binomial was used to model costs per stay and costs per day.
RESULTS:
The most common category observed was 2 or 3 chronic conditions (37.8 % of patients), followed by 4 or 5 chronic conditions (30.1 % of patients) and by 6+ chronic conditions (10.1 %). Compared with costs for patients with 0 or 1 chronic condition, hospitalization costs per stay for overall ambulatory care sensitive conditions were 19 % higher for those with 2 or 3 (95 % confidence interval [CI] 1.19-1.20), 32 % higher for those with 4 or 5 (95 % CI 1.31-1.32), and 31 % higher (95 % CI 1.30-3.32) for those with 6+ conditions. Acute condition stays were 11 % longer when 2 or 3 chronic conditions were present (95 % CI 1.11-1.12), 21 % longer when 4 or 5 were present (95 % CI 1.20-1.22), and 27 % longer when 6+ were present (95 % CI 1.26-1.28) compared with those with 0 or 1 chronic condition. Similar results were seen within chronic conditions. Associations between MCCs and total costs were driven by longer stays among those with more chronic conditions rather than by higher costs per day.
CONCLUSIONS:
The presence of MCCs increased inpatient costs for ambulatory care sensitive conditions via longer hospital stays.
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