title: [Predicting individual risk of high healthcare cost to identify complex chronic patients].
abstract: OBJECTIVE
  To develop a predictive model for the risk of high consumption of healthcare resources, and assess the ability of the model to identify complex chronic patients.
  
  
  METHODS
  A cross-sectional study was performed within a healthcare management organization by using individual data from 2 consecutive years (88,795 people). The dependent variable consisted of healthcare costs above the 95th percentile (P95), including all services provided by the organization and pharmaceutical consumption outside of the institution. The predictive variables were age, sex, morbidity-based on clinical risk groups (CRG)-and selected data from previous utilization (use of hospitalization, use of high-cost drugs in ambulatory care, pharmaceutical expenditure). A univariate descriptive analysis was performed. We constructed a logistic regression model with a 95% confidence level and analyzed sensitivity, specificity, positive predictive values (PPV), and the area under the ROC curve (AUC).
  
  
  RESULTS
  Individuals incurring costs >P95 accumulated 44% of total healthcare costs and were concentrated in ACRG3 (aggregated CRG level 3) categories related to multiple chronic diseases. All variables were statistically significant except for sex. The model had a sensitivity of 48.4% (CI: 46.9%-49.8%), specificity of 97.2% (CI: 97.0%-97.3%), PPV of 46.5% (CI: 45.0%-47.9%), and an AUC of 0.897 (CI: 0.892 to 0.902).
  
  
  CONCLUSIONS
  High consumption of healthcare resources is associated with complex chronic morbidity. A model based on age, morbidity, and prior utilization is able to predict high-cost risk and identify a target population requiring proactive care.
authors.affiliation: Grup de Recerca en Serveis Sanitaris i Resultats en Salut (GReSSiReS), Palamós (Girona), España; Serveis de Salut Integrats Baix Empordà (SSIBE). Palamós, Girona, España.
authors.forename: Jordi
authors.initials: J
authors.lastname: Coderch
authors.affiliation: Grup de Recerca en Serveis Sanitaris i Resultats en Salut (GReSSiReS), Palamós (Girona), España; Serveis de Salut Integrats Baix Empordà (SSIBE). Palamós, Girona, España.
authors.forename: Inma
authors.initials: I
authors.lastname: Sánchez-Pérez
authors.affiliation: Grup de Recerca en Serveis Sanitaris i Resultats en Salut (GReSSiReS), Palamós (Girona), España; Barcelona Graduate School of Economics, Barcelona, España; Centre de Recerca en Economia i Salut, Barcelona, España.
authors.forename: Pere
authors.initials: P
authors.lastname: Ibern
authors.affiliation: Grup de Recerca en Serveis Sanitaris i Resultats en Salut (GReSSiReS), Palamós (Girona), España; Serveis de Salut Integrats Baix Empordà (SSIBE). Palamós, Girona, España.
authors.forename: Marc
authors.initials: M
authors.lastname: Carreras
authors.affiliation: Grup de Recerca en Serveis Sanitaris i Resultats en Salut (GReSSiReS), Palamós (Girona), España; Serveis de Salut Integrats Baix Empordà (SSIBE). Palamós, Girona, España.
authors.forename: Xavier
authors.initials: X
authors.lastname: Pérez-Berruezo
authors.affiliation: Grup de Recerca en Serveis Sanitaris i Resultats en Salut (GReSSiReS), Palamós (Girona), España; Serveis de Salut Integrats Baix Empordà (SSIBE). Palamós, Girona, España. Electronic address: jminoriza@ssibe.cat.
authors.forename: José M
authors.initials: JM
authors.lastname: Inoriza
mesh_terms: D000553:Ambulatory Care / Q000191:economics / Q000706:statistics & numerical data; D019540:Area Under Curve; D002908:Chronic Disease / Q000191:economics* / Q000453:epidemiology; D015897:Comorbidity; D003430:Cross-Sectional Studies; D019033:Delivery of Health Care, Integrated / Q000191:economics* / Q000706:statistics & numerical data; D003953:Diagnosis-Related Groups; D005260:Female; D005544:Forecasting; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006279:Health Maintenance Organizations / Q000191:economics* / Q000706:statistics & numerical data; D006295:Health Resources / Q000191:economics* / Q000706:statistics & numerical data; D006301:Health Services Needs and Demand; D006760:Hospitalization / Q000191:economics; D006801:Humans; D008297:Male; D018803:Models, Economic; D011237:Predictive Value of Tests; D011306:Prescription Fees / Q000706:statistics & numerical data; D012306:Risk; D012680:Sensitivity and Specificity; D013030:Spain / Q000453:epidemiology
keywords: Ajuste de riesgo; Anciano frágil; Chronic disease; Costos de la atención en salud; Enfermedad crónica; Forecasting; Frail elderly; Health care costs; Integrated health care systems; Logistic models; Modelos logísticos; Modelos predictivos; Morbidity; Morbilidad; Prestación integrada de atención de salud; Risk adjustment