title: The effects of multiple chronic conditions on hospitalization costs and utilization for ambulatory care sensitive conditions in the United States: a nationally representative cross-sectional study.
abstract: BACKGROUND
  The presence of multiple chronic conditions (MCCs) complicates inpatient hospital care, leading to higher costs and utilization. Multimorbidity also complicates primary care, increasing the likelihood of hospitalization for ambulatory care sensitive conditions. The purpose of this study was to evaluate how MCCs relate to inpatient hospitalization costs and utilization for ambulatory care sensitive conditions.
  
  
  METHODS
  The 2012 Agency for Healthcare Research and Quality (AHRQ) Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases (SID) provided data to carry out a cross-sectional analysis of 1.43 million claims related to potentially preventable hospitalizations classified by the AHRQ Prevention Quality Indicator (PQI) composites. Categories of MCCs (0-1, 2-3, 4-5, and 6+) were examined in sets of acute, chronic, and overall PQIs. Multivariate models determined associations between categories of MCCs and 1) inpatient costs per stay, 2) inpatient costs per day, and 3) length of inpatient hospitalization. Negative binomial was used to model costs per stay and costs per day.
  
  
  RESULTS
  The most common category observed was 2 or 3 chronic conditions (37.8 % of patients), followed by 4 or 5 chronic conditions (30.1 % of patients) and by 6+ chronic conditions (10.1 %). Compared with costs for patients with 0 or 1 chronic condition, hospitalization costs per stay for overall ambulatory care sensitive conditions were 19 % higher for those with 2 or 3 (95 % confidence interval [CI] 1.19-1.20), 32 % higher for those with 4 or 5 (95 % CI 1.31-1.32), and 31 % higher (95 % CI 1.30-3.32) for those with 6+ conditions. Acute condition stays were 11 % longer when 2 or 3 chronic conditions were present (95 % CI 1.11-1.12), 21 % longer when 4 or 5 were present (95 % CI 1.20-1.22), and 27 % longer when 6+ were present (95 % CI 1.26-1.28) compared with those with 0 or 1 chronic condition. Similar results were seen within chronic conditions. Associations between MCCs and total costs were driven by longer stays among those with more chronic conditions rather than by higher costs per day.
  
  
  CONCLUSIONS
  The presence of MCCs increased inpatient costs for ambulatory care sensitive conditions via longer hospital stays.
authors.affiliation: Truven Health Analytics, 4819 Emperor Blvd., Suite 125, Durham, NC, 27703, USA. hal.skinner@truvenhealth.com.
authors.forename: Halcyon G
authors.initials: HG
authors.lastname: Skinner
authors.affiliation: Truven Health Analytics, 7700 Old Georgetown Rd., Bethesda, MD, 20814, USA.
authors.forename: Rosanna
authors.initials: R
authors.lastname: Coffey
authors.affiliation: Truven Health Analytics, 7700 Old Georgetown Rd., Bethesda, MD, 20814, USA.
authors.forename: Jenna
authors.initials: J
authors.lastname: Jones
authors.affiliation: Agency for Healthcare Research and Quality, 5600 Fishers Lane, Rockville, MD, 20857, USA.
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Heslin
authors.affiliation: Agency for Healthcare Research and Quality, 5600 Fishers Lane, Rockville, MD, 20857, USA.
authors.forename: Ernest
authors.initials: E
authors.lastname: Moy
mesh_terms: D000553:Ambulatory Care / Q000191:economics / Q000706:statistics & numerical data; D002908:Chronic Disease / Q000191:economics*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000191:economics / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology; D016270:United States Agency for Healthcare Research and Quality