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Characterizing the Senior High Cost User (HCU) in Ontario

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ClinicalTrials.gov Identifier: NCT02815930
Recruitment Status : Active, not recruiting
First Posted : June 28, 2016
Last Update Posted : March 8, 2019
Sponsor:
Collaborators:
Ontario Drug Policy Research Network (ODPRN)
Research Institute of St. Joseph's Hamilton
Information provided by (Responsible Party):
McMaster University

Brief Summary:
High cost users (HCUs) are a small group of patients who use a disproportionate amount of health care resources. This study is a retrospective population-based matched cohort analysis of newly incident senior High Cost Users (HCUs) defined as Ontarians aged 66 years or older in the top 5% of healthcare expenditure users in fiscal year 2013 (FY2013). The study objectives are to characterize and contrast Ontario senior HCUs to non-HCUs based on their demographics, co-morbidities, medication use, health service utilization, healthcare expenditures, medication costs and clinical outcomes, and to determine the relative contribution of medications to senior HCUs expenditures

Condition or disease Intervention/treatment
Senior High Cost Users (HCU) Other: HCU Status

Detailed Description:
Senior high cost users (HCUs) with annual healthcare expenditures within the top 5% of Ontarians will be identified using established ICES costing algorithms. This cohort will be matched to a cohort of non-HCUs using a 3:1 matching ratio (non-HCU to HCU) based on age at cohort entry (+/- 1 month), sex and geographic location of residence (based on LHIN) for comparative analysis. Descriptive statistics will be used to describe the study populations and outcomes. Regression analyses will be used to adjust for potential confounders when analyzing healthcare resource utilization and costs as a function of HCU status (e.g. income, type of residence, co-morbidities, rural/urban) and/or when analyzing sub-populations [e.g. chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF)]. Logistic regression will be performed using the patient level data to predict the impact of individual factors on the likelihood of becoming a senior HCU.

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Study Type : Observational
Estimated Enrollment : 700000 participants
Observational Model: Cohort
Time Perspective: Retrospective
Official Title: Characterizing the Senior High Cost User in Ontario: A Population-Based Matched Cohort Study
Study Start Date : April 2012
Actual Primary Completion Date : March 2014
Estimated Study Completion Date : December 2019

Group/Cohort Intervention/treatment
HCUs
Newly incident seniors with annual total healthcare expenditures in the top 5% of Ontarians
Other: HCU Status
Total healthcare expenditures in the top 5% of Ontarians

Non-HCUs
Seniors with annual total healthcare expenditures below the top 5% of Ontarians



Primary Outcome Measures :
  1. Total healthcare expenditures per patient [ Time Frame: 1 year after index date ]
  2. Total drug costs per patient [ Time Frame: 1 year after index date ]
  3. Drug cost to total healthcare expenditure ratio [ Time Frame: 1 year after index date ]

Secondary Outcome Measures :
  1. All-cause mortality [ Time Frame: 1 year after index date ]
  2. All-cause hospitalization rate [ Time Frame: 1 year after index date ]


Information from the National Library of Medicine

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Ages Eligible for Study:   66 Years to 105 Years   (Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Sampling Method:   Non-Probability Sample
Study Population
Newly incident senior high cost users (HCUs) in Ontario
Criteria

Inclusion Criteria:

  • Ontario residents registered in RPDB between April 1, 2013 - March 31, 2014
  • Annual total health care expenditures in FY2013 equal to or greater than financial threshold for the top 5% of all Ontarians

Exclusion Criteria:

  • Death on OR prior to index date
  • Age > 105
  • Annual total health care expenditures in FY2012 fiscal year greater than financial threshold of 5% of all Ontarians in FY2013

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02815930


Sponsors and Collaborators
McMaster University
Ontario Drug Policy Research Network (ODPRN)
Research Institute of St. Joseph's Hamilton
Investigators
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Principal Investigator: Justin Lee, BScPhm, ACPR, MD, FRCPC McMaster University

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Responsible Party: McMaster University
ClinicalTrials.gov Identifier: NCT02815930     History of Changes
Other Study ID Numbers: 2016 0760 236 000
First Posted: June 28, 2016    Key Record Dates
Last Update Posted: March 8, 2019
Last Verified: March 2019
Keywords provided by McMaster University:
High cost user (HCU)
Healthcare utilization
Healthcare expenditures
Medication use
Medication expenditures
Multimorbidity
Observational study