Characterizing the Senior High Cost User (HCU) in Ontario

• Conditions: Senior High Cost Users (HCU)
• Interventions: Other: HCU Status

• Registration Number: NCT02815930
• Lead Sponsor: McMaster University

Brief Summary

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

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.

Basic Information
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Recruitment & Eligibility
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Study & Design

Study Timeline

• Study Start: 2012-04
• Primary Completion: 2014-03
• Study First Submitted: 2016-06-24
• Study First Submitted QC: 2016-06-24
• Study First Posted: 2016-06-28
• Status Verified: 2019-03
• Last Update Submitted: 2020-02-04
• Last Update Posted: 2020-02-05
• Study Completion: 2020-12

Recruitment & Eligibility

• Status: UNKNOWN
• Sex: All
• Target Recruitment: 700000

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

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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

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Study & Design

• Study Type: OBSERVATIONAL
• Study Design: Not specified

Arm && Interventions

Group	Intervention	Description
HCUs	HCU Status	Newly incident seniors with annual total healthcare expenditures in the top 5% of Ontarians

Primary Outcome Measures

Name	Time	Method
Total healthcare expenditures per patient	1 year after index date
Drug cost to total healthcare expenditure ratio	1 year after index date
Total drug costs per patient	1 year after index date

Secondary Outcome Measures

Name	Time	Method
All-cause mortality	1 year after index date
All-cause hospitalization rate	1 year after index date