Characterizing the Senior High Cost User (HCU) in Ontario

Study Overview
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Brief Summary
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High cost users (HCUs) are a small group of patients who use a disproportionate amount of health care resources. This study is a retrospective population-based matched cohort analysis of newly incident senior High Cost Users (HCUs) defined as Ontarians aged 66 years or older in the top 5% of healthcare expenditure users in fiscal year 2013 (FY2013). The study objectives are to characterize and contrast Ontario senior HCUs to non-HCUs based on their demographics, co-morbidities, medication use, health service utilization, healthcare expenditures, medication costs and clinical outcomes, and to determine the relative contribution of medications to senior HCUs expenditures

Detailed Description
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Senior high cost users (HCUs) with annual healthcare expenditures within the top 5% of Ontarians will be identified using established ICES costing algorithms. This cohort will be matched to a cohort of non-HCUs using a 3:1 matching ratio (non-HCU to HCU) based on age at cohort entry (+/- 1 month), sex and geographic location of residence (based on LHIN) for comparative analysis. Descriptive statistics will be used to describe the study populations and outcomes. Regression analyses will be used to adjust for potential confounders when analyzing healthcare resource utilization and costs as a function of HCU status (e.g. income, type of residence, co-morbidities, rural/urban) and/or when analyzing sub-populations [e.g. chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF)]. Logistic regression will be performed using the patient level data to predict the impact of individual factors on the likelihood of becoming a senior HCU.

Official Title
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Characterizing the Senior High Cost User in Ontario: A Population-Based Matched Cohort Study

Conditions
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Senior High Cost Users (HCU)

Intervention / Treatment
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* Other: HCU Status


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Ontario residents registered in RPDB between April 1, 2013 - March 31, 2014 Annual total health care expenditures in FY2013 equal to or greater than financial threshold for the top 5% of all Ontarians Exclusion Criteria: Death on OR prior to index date Age > 105 Annual total health care expenditures in FY2012 fiscal year greater than financial threshold of 5% of all Ontarians in FY2013

Ages Eligible for Study
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Minimum Age: 66 Years
Maximum Age: 105 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| HCUs<br>Newly incident seniors with annual total healthcare expenditures in the top 5% of Ontarians | Other: HCU Status<br>* Total healthcare expenditures in the top 5% of Ontarians<br>|
| Non-HCUs<br>Seniors with annual total healthcare expenditures below the top 5% of Ontarians | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Total healthcare expenditures per patient |  | 1 year after index date | 
| Total drug costs per patient |  | 1 year after index date | 
| Drug cost to total healthcare expenditure ratio |  | 1 year after index date | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| All-cause mortality |  | 1 year after index date | 
| All-cause hospitalization rate |  | 1 year after index date | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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High cost user (HCU), Healthcare utilization, Healthcare expenditures, Medication use, Medication expenditures, Multimorbidity, Observational study