As the population ages, more people are living with long-term, complex conditions. These conditions result in substantial burden for patients and their families and in high need for health care. We are considering three high-need patient personas:
- an older person with advancing illness
- a frail older person
- a person with major complex chronic conditions
The way these high-need patients are managed within the health system varies across countries. This international study will describe what kind of health care these patients use and the costs and quality of that care. Information from England will be compared with information from another 10 countries. Taking account of differences in the cost of living, analysis will highlight countries which have particularly high or low total health care costs, or high or low costs in certain parts of the health system (e.g. costs arising from patients being admitted to hospital, or from medications they are prescribed). It will also highlight countries which have particularly high quality of care. This will help policymakers target aspects of health care that can be changed and that either make up a large burden of cost or make an important difference to the quality of care that these patients receive.
Objectives: Greater understanding of the health care provided for high-need patients offers an opportunity to improve outcomes, value and health. We focus on three high-need patient personas (an older person with dementia, an older person hospitalised for hip fracture, and someone hospitalised with heart failure who has co-morbidity). This international comparative study will: harmonise the operationalisation of these patient personas using data from 11 countries; compare total health care spending (using available data on direct costs to the NHS) and care quality; and compare differences in the specific patterns of health care utilisation (e.g. emergency admission versus in-patient care versus community prescribing). It builds on project reference ISAC 17_150R which compared high-cost patients across countries.
Methods: A cross-sectional study of anonymised CPRD patients registered in 2012-2016 with i) prevalent dementia and aged 65-90, ii) hospital admission for hip fracture and aged 65-90, iii) hospital admission for heart failure plus prevalent diabetes or COPD. Data on costs (including inpatient and outpatient care, emergency admissions, and prescribed medications), utilisation and care quality indicators (including continuity of care, appointment length) over a 12-month period will be derived from CPRD and linked Hospital Episode Statistics and ONS mortality records.
Data Analysis: This is a descriptive study. Comparators are the same patient personas in the other 10 collaborating countries. We will additionally describe costs, utilisation and care quality by gender, age group (65-75, 75-90 years), and IMD quintile. Adjustment will be made for possible confounding by ethnicity, rurality, living alone, number of chronic conditions and practice level practitioner supply.
Types of health care utilisation
- Quality of care indicators
- Cost of health care utilisation
Hannah Knight - Chief Investigator - The Health Foundation
Yannis Kotrotsios - Corresponding Applicant - The Health Foundation
Adam Steventon - Collaborator - The Health Foundation
Arne Wolters - Collaborator - The Health Foundation
Carlotta Greci - Collaborator - The Health Foundation
Fiona Grimm - Collaborator - The Health Foundation
Julia Shen - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Karen Hodgson - Collaborator - The Health Foundation
Kathryn Dreyer - Collaborator - The Health Foundation
Mai Stafford - Collaborator - The Health Foundation
Sarah Deeny - Collaborator - The Health Foundation
Will Parry - Collaborator - The Health Foundation
Sarah Deeny - Chief Investigator - The Health Foundation
HES Accident and Emergency;HES Admitted Patient Care;HES Outpatient;ONS Death Registration Data;Patient Level Index of Multiple Deprivation;Practice Level Index of Multiple Deprivation