Abstract
Background
Administrative data sets lack functional measures.
Aim
We examined whether trajectories of cost can be used as a marker of functional recovery after hospitalization.
Methods
Secondary analysis of the National Health and Aging Trends Study merged with Centers for Medicare and Medicaid Services data. Community-dwelling participants with a first hospitalization occurring after any annual survey were included (N = 937). Monthly total cost trajectories were constructed for the 3 months before and 3 months following hospitalization. Growth mixture models identified groups of patients with similar trajectories. The association of cost classes with five functional outcomes was examined using multivariate models, controlling for pre-hospitalization function and lead time.
Results
Four cost trajectory classes describing common recovery patterns were identified—persistently high, persistently moderate, low-spike-recover, and low variable. Cost class membership was significantly associated with change in Activities of Daily Living (ADL), instrumental ADL, Short Physical Performance Battery, and grip strength (p < 0.005), but not gait speed (p = 0.08). The proportion of patients who maintained or improved SPPB score was 46.8% in the persistently high, 49.2% in the persistently moderate, 52.7% in the low-spike-recover, and 57.2% in the low-variable groups. In models adjusted for known predictors of functional outcome, the magnitude and direction of association was maintained but significance was lost, indicating that cost trajectories’ mirror is mediated by predictors of recovery not available in administrative data.
Conclusion
Cost trajectories and total costs are associated with functional recovery following hospitalization in older adults. Cost may be useful as a measure of recovery in administrative data.
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References
Boyd CM, Landefeld CS, Counsell SR et al (2008) Recovery of activities of daily living in older adults after hospitalization for acute medical illness. J Am Geriatr Soc 56:2171–2179. https://doi.org/10.1111/j.1532-5415.2008.02023.x
Whitson HE, Duan-Porter W, Schmader KE et al (2016) Physical resilience in older adults: systematic review and development of an emerging construct. J Gerontol A Biol Sci Med Sci 71:489–495. https://doi.org/10.1093/gerona/glv202
Hadley EC, Kuchel GA, Newman AB et al (2017) Report: NIA workshop on measures of physiologic resiliencies in human aging. J Gerontol Ser A 72:980–990. https://doi.org/10.1093/gerona/glx015
Fassbender K, Fainsinger RL, Carson M et al (2009) Cost trajectories at the end of life: the canadian experience. J Pain Symptom Manage 38:75–80. https://doi.org/10.1016/j.jpainsymman.2009.04.007
Akushevich I, Kravchenko J, Akushevich L et al (2011) Medical cost trajectories and onsets of cancer and noncancer diseases in US elderly population. Comput Math Methods Med 2011:14. https://doi.org/10.1155/2011/857892
Parthasarathy S, Chi FW, Mertens JR et al (2012) The role of continuing care on 9-year cost trajectories of patients with intakes into an outpatient alcohol and drug treatment program. Med Care 50:540–546. https://doi.org/10.1097/MLR.0b013e318245a66b
Sundberg T, Petzold M, Kohls N et al (2014) Opposite drug prescription and cost trajectories following integrative and conventional care for pain—A case-control study. PLoS ONE 9:e96717. https://doi.org/10.1371/journal.pone.0096717
Maciejewski ML, Arterburn DE (2013) Cost-effectiveness of bariatric surgery. JAMA 310:742–743. https://doi.org/10.1001/jama.2013.276131
Patel KV, Guralnik JM, Dansie EJ et al (2013) Prevalence and impact of pain among older adults in the United States: findings from the 2011 National Health and Aging Trends Study. Pain 154:2649–2657. https://doi.org/10.1016/j.pain.2013.07.029
Montaquila J, Freedman V, Edwards B et al (2012) National health and aging trends study, round 1 sample design and selection. NHATS Technical Paper #1
Freedman VA, Kasper JD, Cornman JC et al (2011) Validation of new measures of disability and functioning in the National Health and Aging Trends Study. J Gerontol 66A:1013–1021. https://doi.org/10.1093/gerona/glr087
Guralnik JM, Simonsick EM, Ferrucci L et al (1994) A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol 49:M85–M94. https://doi.org/10.1093/geronj/49.2.M85
Nylund K, Asparouhov T, Muthén B (2007) Deciding on the number of classes in latent class analysis and growth mixture modeling: a Monte Carlo simulation study. Struct Equ Model A Multi J 14:535–569
van de Schoot R (2015) Latent trajectory studies: the basics, how to interpret the results, and what to report. Eur J Psychotraumatol. https://doi.org/10.3402/ejpt.v6.27514
Gaugler JE, Hovater M, Roth DL et al (2013) Analysis of cognitive, functional, health service use, and cost trajectories prior to and following memory loss. J Gerontol Ser B 68:562–567. https://doi.org/10.1093/geronb/gbs078
Yelin E, Wanke LA (1999) An assessment of the annual and long-term direct costs of rheumatoid arthritis: the impact of poor function and functional decline. Arthritis Rheum 42:1209–1218. https://doi.org/10.1002/1529-0131(199906)42:6%3c1209:AID-ANR18%3e3.0.CO;2-M
Robinson TN, Wu DS, Stiegmann GV et al (2011) Frailty predicts increased hospital and six-month healthcare cost following colorectal surgery in older adults. Am J Surg 202:511–514. https://doi.org/10.1016/j.amjsurg.2011.06.017
Funding
This work was supported by the National Institute on Aging of the National Institutes of Health (UH2 AG056925-01 and K24 AG049077-01A1 to CCE; 2P30AG028716-11 to Kenneth Schmader). The funding agency had no role in the analysis, interpretation, or manuscript preparation.
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CSC—Study conception and design, interpretation of analysis, and drafting of manuscript. JH—Statistical analysis and interpretation, and review of manuscript. CFP—Study design, statistical analysis and interpretation, and review of manuscript. JPB—Study design, interpretation, and review of manuscript. DLR—Data acquisition, interpretation of analysis, and review of manuscript. OCS—Data acquisition, study design, interpretation, and review of manuscript.
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Use of this data set was approved by the Institutional Review Board of Johns Hopkins University.
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While participants in the original NHATs study provided individual informed consent, a waiver was granted for this secondary data analysis with a limited data set.
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All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation, both institutional and national. No animals were involved in this research.
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Colón-Emeric, C.S., Huang, J., Pieper, C.F. et al. Cost trajectories as a measure of functional resilience after hospitalization in older adults. Aging Clin Exp Res 32, 2595–2601 (2020). https://doi.org/10.1007/s40520-020-01481-8
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DOI: https://doi.org/10.1007/s40520-020-01481-8