title: The effect of multidisciplinary heart failure clinic characteristics on 1-year postdischarge health care costs: a population-based study.
abstract: BACKGROUND
  Although multidisciplinary heart failure (HF) clinics are efficacious, it is not known how patient factors or HF clinic structural indicators and process measures have an impact on the cumulative health care costs.
  
  
  METHODS
  In this retrospective cohort study using administrative databases in Ontario, Canada, we identified 1216 HF patients discharged alive after an acute care hospitalization in 2006 and treated at a HF clinic. The primary outcome was the cumulative 1-year health care costs. A hierarchical generalized linear model with a logarithmic link and gamma distribution was developed to determine patient-level and clinic-level predictors of cost.
  
  
  RESULTS
  The mean 1-year cost was $27,809 (range, $69 to $343,743). There was a 7-fold variation in the mean costs by clinic, from $14,670 to $96,524. Delays in being seen at a HF clinic were a significant patient-level predictor of costs (rate ratio 1.0015 per day; P<0.001). Being treated at a clinic with >3 physicians was associated with lower costs (rate ratio 0.78; P=0.035). Unmeasured patient-level differences accounted for 97.4% of the between-patient variations in cost. The between-clinic variation in costs decreased by 16.3% when patient-level factors were accounted for; it decreased by a further 49.8% when clinic-level factors were added.
  
  
  CONCLUSIONS
  From a policy perspective, the wide spectrum of HF clinic structure translates to inefficient care. Greater guidance as to the type of patient seen at a HF clinic, the timeliness of the initial visit, and the most appropriate structure of the HF clinics may potentially result in more cost-effective care.
authors: *Schulich Heart Centre, Division of Cardiology, Sunnybrook Health Sciences Centre †Toronto Health Economics and Technology Assessment (THETA) Collaborative ‡Institute of Health Policy, Management and Evaluation §Institute for Clinical Evaluative Sciences (ICES) ∥Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada.
authors: Harindra C
authors: HC
authors: Wijeysundera
authors: Peter C
authors: PC
authors: Austin
authors: Xuesong
authors: X
authors: Wang
authors: Maria C
authors: MC
authors: Bennell
authors: Lusine
authors: L
authors: Abrahamyan
authors: Dennis T
authors: DT
authors: Ko
authors: Jack V
authors: JV
authors: Tu
authors: Murray
authors: M
authors: Krahn
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000554:Ambulatory Care Facilities / Q000191:economics / Q000458:organization & administration* / Q000706:statistics & numerical data*; D015897:Comorbidity; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009864:Ontario; D010348:Patient Care Team / Q000458:organization & administration*; D012189:Retrospective Studies; D012737:Sex Factors; D013995:Time; D013997:Time Factors