title: Identification of high resource utilizing patients on internal medicine hospital services.
abstract: In order to provide high quality, cost-efficient care, it is critical to understand drivers of the cost of care. Therefore, we sought to identify clinical variables associated with high utilization (cost) in patients admitted to medical services and to develop a robust model to identify high utilization patients. In this case-control analysis, cases were identified as the 200 most costly patients admitted to internal medicine/internal medicine subspecialty services using our institution's computerized clinical data warehouse over a 7-month time period (November 1, 2012-May 31, 2013). 400 patients admitted in the same time period were randomly selected to serve as controls. The mean cost for the highest utilization patients was $126,343, while that for randomly matched patients was $15,575. In a multivariable regression model, the following variables were associated with high utilization of resources: African American race, age 35-44, admission through the emergency department, primary service of hematology-oncology, a history of heart failure or paralysis, a diagnosis of HIV, cancer, collagen vascular diseases and/or coagulopathy, a reduced albumin, and/or an elevated creatinine. The in hospital mortality rate for high utilization patients was 19%, compared to 8% for controls (p=0.0002). A predictive model using 14 different readily available clinical variables predicted high utilization with an area under the curve of 0.85. The data suggest that high utilization patients share similar demographic and clinical features. We speculate that a predictive model using commonly known patient characteristics should be able to predict high utilization patients.
authors.affiliation: Department of Internal Medicine, Division of General Internal Medicine, Vanderbilt University, Nashville, Tennessee, USA.
authors.forename: David W
authors.initials: DW
authors.lastname: Walsh
authors.affiliation: Department of Internal Medicine, Medical University of South Carolina University, Charleston, South Carolina, USA.
authors.forename: Molly C
authors.initials: MC
authors.lastname: McVey
authors.affiliation: Department of Internal Medicine, Medical University of South Carolina University, Charleston, South Carolina, USA.
authors.forename: Abigal
authors.initials: A
authors.lastname: Gass
authors.affiliation: Department of Internal Medicine, Medical University of South Carolina University, Charleston, South Carolina, USA Division of General Internal Medicine, Medical University of South Carolina University, Charleston, South Carolina, USA.
authors.forename: Jingwen
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Department of Internal Medicine, Medical University of South Carolina University, Charleston, South Carolina, USA Division of General Internal Medicine, Medical University of South Carolina University, Charleston, South Carolina, USA.
authors.forename: Patrick D
authors.initials: PD
authors.lastname: Mauldin
authors.affiliation: Department of Internal Medicine, Medical University of South Carolina University, Charleston, South Carolina, USA.
authors.forename: Don C
authors.initials: DC
authors.lastname: Rockey
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003710:Demography; D005260:Female; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007388:Internal Medicine / Q000191:economics; D008297:Male; D008875:Middle Aged; D055815:Young Adult
keywords: Academic Medical Centers; Inpatients; Intensive Care