Health Service Utilization Patterns Among Adults With Congenital Heart Disease: A Population‐Based Study

Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease

Havi Murad¹  Michal Benderly²  Ofra Kalter‐Leibovici²  Ran Balicer³  Efrat Mazor Dray⁴  Yaron Razon⁴  Amiram Nir⁵  Avraham Lorber⁶  Sergei Yalonetsky⁶  Leonard Blieden⁷  Jonathan Buber⁷  Gabriel Chodick⁷  Dahlia Weitzman⁷  Rafael Hirsch⁷  Alexander Dadashev⁷ 

[1] Biostatistics Unit Gertner Institute for Epidemiology and Health Policy Research Sheba Medical Center Ramat‐Gan Israel;Cardiovascular Epidemiology Unit Gertner Institute for Epidemiology and Health Policy Research Sheba Medical Center Ramat‐Gan Israel;Clalit Research Institute Clalit Health Services Tel Aviv Israel;Faculty of Health Sciences Ben‐Gurion University of the Negev Negev Israel;Pediatric Cardiology and Adult Congenital Heart Disease Unit Shaare Zedek Medical Center Jerusalem Israel;Pediatric Cardiology and GUCH Unit Rambam Health Care CampusTechnion Faculty of Medicine Haifa Israel;Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel;

关键词: adult congenital heart disease;    healthcare service utilization;    mortality;    population‐based study;   

DOI  :  10.1161/JAHA.120.018037

来源: DOAJ

【 摘 要 】

Background Several studies have examined hospitalizations among patients with adult congenital heart disease (ACHD). Few investigated other services or utilization patterns. Our aim was to study service utilization patterns and predictors among patients with ACHD. Methods and Results We identified 11 653 patients with ACHD aged ≥18 years (median, 47 years), through electronic records of 2 large Israeli healthcare providers (2007–2011). The association between patient, disease, and sociogeographic characteristics and healthcare resource utilization were modeled as recurrent events accounting for the competing death risk. Patients with ACHD had high healthcare utilization rates compared with the general population. The highest standardized service utilization ratios (SSRs) were found among patients with complex congenital heart disease including primary care visits (SSR, 1.53; 95% CI, 1.47–1.58), cardiology outpatient visits (SSR, 5.17; 95% CI, 4.69–5.64), hospitalizations (SSR, 6.68; 95% CI, 5.82–7.54), and days in hospital (SSR, 15.37; 95% CI, 14.61–16.12). Adjusted resource utilization hazard increased with increasing lesion complexity. Hazard ratios (HRs) for complex versus simple disease were: primary care (HR, 1.14; 95% CI, 1.06–1.23); cardiology outpatient visits (HR, 1.40; 95% CI, 1.24–1.59); emergency department visits (HR, 1.19; 95% CI, 1.02–1.39); and hospitalizations (HR, 1.75; 95% CI, 1.49–2.05). Effects attenuated with age for cardiology outpatient visits and hospitalizations and increased for emergency department visits. Female sex, geographic periphery, and ethnic minority were associated with more primary care visits, and female sex (HR versus men, 0.89 [95% CI, 0.84–0.94]) and periphery (HR, 0.72 [95% CI, 0.58–0.90] for very peripheral versus very central) were associated with fewer cardiology visits. Arab minority patients also had high hospitalization rates compared with the majority group of Jewish or other patients. Conclusions Healthcare utilization rates were high among patients with ACHD. Female sex, geographic periphery, and ethnicity were associated with less optimal service utilization patterns. Further research should examine strategies to optimize service utilization in these groups.

【 授权许可】

Unknown