title: Identifying Patients With Undiagnosed Chronic Conditions: An Examination of Patient Costs Before Chronic Disease Diagnosis.
abstract: OBJECTIVE
  Identifying chronic conditions at earlier stages could produce dramatic savings to the health care system. This study sought to determine whether patients with chronic conditions experienced higher medical costs and imaging costs than patients with nonchronic conditions before the onset of chronic disease.
  
  
  METHODS
  This retrospective study linked 2004-2012 Medicare Chronic Conditions Warehouse data to Medicare fee-for-service claims data, to examine whether elderly patients that have chronic conditions experienced higher overall medical costs, imaging costs, and imaging share of costs before their diagnosis, compared with patients who have nonchronic conditions, during the same period. Student's t tests were conducted comparing the mean annual costs and imaging share for patients with chronic conditions and patients with nonchronic conditions, for the six years before their diagnosis and two years afterward.
  
  
  RESULTS
  Imaging costs for patients with chronic conditions were 9 times higher (P < .001) for 6 years before they were diagnosed with a chronic condition; overall medical costs were 18 times (P < .001) higher than those for patients with nonchronic conditions. A significant (P < .001) but small difference was found between the mean imaging share for patients with, versus without, a chronic condition, up until two years before diagnosis, at which point overall medical costs, imaging costs, and imaging share dramatically increased.
  
  
  CONCLUSIONS
  Overall medical costs and imaging costs for patients with chronic conditions are significantly and substantially higher than those for patients with nonchronic conditions for many years before they are diagnosed with chronic conditions. Tracking health care expenditures may identify patients with chronic conditions sooner, potentially producing large savings within the health care system.
authors.affiliation: Harvey L. Neiman Health Policy Institute, Reston, Virginia; Department of Economics, George Mason University, Fairfax, Virginia. Electronic address: ddeyo@neimanhpi.org.
authors.forename: Darwyyn
authors.initials: D
authors.lastname: Deyo
authors.affiliation: Harvey L. Neiman Health Policy Institute, Reston, Virginia.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Hemingway
authors.affiliation: Harvey L. Neiman Health Policy Institute, Reston, Virginia; Department of Health Administration and Policy, George Mason University, Fairfax, Virginia.
authors.forename: Danny R
authors.initials: DR
authors.lastname: Hughes
mesh_terms: D000369:Aged, 80 and over; D002908:Chronic Disease / Q000191:economics* / Q000453:epidemiology*; D003952:Diagnostic Imaging / Q000191:economics* / Q000706:statistics & numerical data; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D006278:Medicare / Q000191:economics*; D015995:Prevalence; D014481:United States / Q000453:epidemiology
keywords: Chronic conditions; health care expenditures; imaging