title: Mosaic segmentation, COPD and CHF multimorbidity and hospital admission costs: a clinical linkage study.
abstract: BACKGROUND
  How multimorbidity and socio-economic factors influence healthcare costs is unknown. Geo-demographic profiling system, Mosaic, which adds to socio-economic factors, provides the potential for an investigation of the relationship with multimorbidity, and their influence on healthcare costs.
  
  
  METHODS
  Using chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) registers from 53 general practices for a population aged 40 years and over in Stoke-on-Trent, England (N = 10,113), were linked to hospital admissions data and Healthcare Resource Groups as a measure of hospital cost (2007-09). Eleven Mosaic groups were linked on the basis of individual patients' post codes.
  
  
  RESULTS
  The COPD and CHF multimorbid group (n = 763) had the highest proportion with at least one hospital admission in the 3-year time period (n = 550, 72%), compared with the index COPD (56%) and CHF (66%) groups. Multimorbid patients had significantly higher mean costs for hospital admission (£4896) compared with the index COPD (£2769) or CHF (£3876). The associations between multimorbid groups and hospital admission costs compared with index groups varied by different Mosaic groups.
  
  
  CONCLUSIONS
  CHF and COPD multimorbidity is associated with high costs, and average hospital admission costs vary by Mosaic segmentation. Multimorbidity and Mosaic provide an innovative basis for developing and targeting healthcare interventions in high-hospital-cost patients.
authors.affiliation: Health Service Research Unit, Innovation Centre 1, Keele University, Staffordshire ST5 5NB, UK.
authors.forename: Lucy
authors.initials: L
authors.lastname: Doos
authors.affiliation: NHS Staffordshire Commissioning Support Service, St George's Chambers, 31 Merrial Street, Newcastle under Lyme, Staffordshire ST5 2AE, UK.
authors.forename: John
authors.initials: J
authors.lastname: Uttley
authors.affiliation: Directorate of Public Health, Civic Centre, Glebe Street, Stoke-on-Trent ST4 1HH, UK.
authors.forename: Ifeoma
authors.initials: I
authors.lastname: Onyia
authors.affiliation: Directorate of Public Health, Civic Centre, Glebe Street, Stoke-on-Trent ST4 1HH, UK.
authors.forename: Zafar
authors.initials: Z
authors.lastname: Iqbal
authors.affiliation: Health Service Research Unit, Innovation Centre 1, Keele University, Staffordshire ST5 5NB, UK.
authors.forename: Peter W
authors.initials: PW
authors.lastname: Jones
authors.affiliation: Health Service Research Unit, Innovation Centre 1, Keele University, Staffordshire ST5 5NB, UK.
authors.forename: Umesh T
authors.initials: UT
authors.lastname: Kadam
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease; D015897:Comorbidity; D004739:England / Q000453:epidemiology; D006302:Health Services Research; D006333:Heart Failure / Q000191:economics*; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000191:economics*; D012042:Registries; D012959:Socioeconomic Factors
keywords: Mosaic; healthcare costs; heart failure; multimorbidity; obstructive lung disease; organization and administration