Clinical outcomes and resource utilisation in Medicare patients with chronic liver disease: a historical cohort study.
OBJECTIVE
The aim of this study is to assess recent trends in health resource utilisation and patient outcomes of Medicare beneficiaries with chronic liver disease (CLD).


METHODS
Liver-related mortality is the 10th leading cause of death in the USA, and hepatitis C virus (HCV) and obesity-related non-alcoholic fatty liver disease are the major causes of CLD. As the US population ages and becomes more obese, the impact of CLD is expected to become more prominent for the Medicare population.


METHODS
This is a retrospective cohort study of Medicare beneficiaries with a diagnosis of CLD based on inpatient (N=21 576; 14 977 unique patients) and outpatient (N=515 990; 244 196 patients) claims from 2005 to 2010.


METHODS
The study outcomes included hospital length of stay (LOS) and inpatient mortality as well as inpatient and outpatient inflation-adjusted payments.


RESULTS
Between 2005 and 2010, there was an annual decrease in LOS of 3.17% for CLD-related hospitalisations. Risk-adjusted in-hospital mortality decreased (OR 0.90, 95% CI 0.87 to 0.94), while short-term postdischarge mortality remained stable (1.00, 0.98 to 1.03). Inpatient per-claim payment increased from $11 769 in 2005 to $12 347 in 2010 (p=0.0006). Similarly, the average yearly payments for outpatient care increased from $366 to $404 (p<0.0001). This change in payment was observed together with a consistent decrease in the proportion of beneficiary-paid amount (25.4-20%, p<0.0001) as opposed to Medicare-paid amount (73.1-80%, p<0.0001). The major predictors of higher outpatient payments were younger age, Asian race or Hispanic ethnicity, living in California, and having more diagnoses and outpatient procedures per claim. The predictors of inpatient spending also included younger age, location and the number of inpatient procedures.


CONCLUSIONS
Length of inpatient stay and inpatient mortality among Medicare beneficiaries with CLD decreased, while inpatient and outpatient spending increased.
Department of Medicine, Inova Fairfax Hospital, Falls Church, Virginia, USA Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia, USA.
Zobair M
ZM
Younossi
Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia, USA.
Li
L
Zheng
Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia, USA.
Maria
M
Stepanova
Department of Medicine, Inova Fairfax Hospital, Falls Church, Virginia, USA.
Chapy
C
Venkatesan
Department of Medicine, Inova Fairfax Hospital, Falls Church, Virginia, USA.
Alita
A
Mishra
D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D015331:Cohort Studies; D005260:Female; D006295:Health Resources / Q000706:statistics & numerical data*; D006801:Humans; D008107:Liver Diseases / Q000628:therapy*; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D014481:United States
Qualitative Research