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The effect of multidisciplinary heart failure clinic characteristics on 1-year postdischarge health care costs: a
Harindra C Wijeysundera1, Peter C Austin, Xuesong Wang
1*Schulich Heart Centre, Division of Cardiology, Sunnybrook Health Sciences Centre †Toronto Health Economics and Technology Assessment (THETA) Collaborative ‡Institute of Health Policy, Management and Evaluation §Institute for Clinical Evaluative Sciences (ICES) ∥Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada.
Insights
Heart failure clinic structure impacts healthcare costs. Timeliness of visits and clinic size influence spending, suggesting a need for standardized guidelines to improve cost-effectiveness.
Area of Science:
- Health Services Research
- Cardiology
- Health Economics
Background:
- Multidisciplinary heart failure (HF) clinics improve patient outcomes.
- However, the influence of patient factors and clinic characteristics on healthcare costs remains unclear.
Purpose of the Study:
- To investigate patient-level and clinic-level predictors of cumulative 1-year healthcare costs in heart failure (HF) patients.
Main Methods:
- Retrospective cohort study of 1216 HF patients in Ontario, Canada, using administrative databases.
- Analysis of cumulative 1-year healthcare costs using a hierarchical generalized linear model.
- Identification of patient-level and clinic-level cost predictors.
Main Results:
- Mean 1-year cost was $27,809, with a 7-fold variation between clinics.
- Delayed HF clinic visits significantly increased costs (rate ratio 1.0015 per day).
- Clinics with >3 physicians were associated with lower costs (rate ratio 0.78).
Conclusions:
- Significant variation in HF clinic structure leads to inefficient care.
- Standardizing patient selection, visit timeliness, and clinic structure can enhance cost-effectiveness.
- Policy guidance is needed for optimal HF clinic operations and resource allocation.
Background:
Although multidisciplinary heart failure (HF) clinics are efficacious, it is not known how patient factors or HF clinic structural indicators and process measures have an impact on the cumulative health care costs.
Research Design:
In this retrospective cohort study using administrative databases in Ontario, Canada, we identified 1216 HF patients discharged alive after an acute care hospitalization in 2006 and treated at a HF clinic. The primary outcome was the cumulative 1-year health care costs. A hierarchical generalized linear model with a logarithmic link and gamma distribution was developed to determine patient-level and clinic-level predictors of cost.
Results:
The mean 1-year cost was $27,809 (range, $69 to $343,743). There was a 7-fold variation in the mean costs by clinic, from $14,670 to $96,524. Delays in being seen at a HF clinic were a significant patient-level predictor of costs (rate ratio 1.0015 per day; P<0.001). Being treated at a clinic with >3 physicians was associated with lower costs (rate ratio 0.78; P=0.035). Unmeasured patient-level differences accounted for 97.4% of the between-patient variations in cost. The between-clinic variation in costs decreased by 16.3% when patient-level factors were accounted for; it decreased by a further 49.8% when clinic-level factors were added.
Conclusions:
From a policy perspective, the wide spectrum of HF clinic structure translates to inefficient care. Greater guidance as to the type of patient seen at a HF clinic, the timeliness of the initial visit, and the most appropriate structure of the HF clinics may potentially result in more cost-effective care.
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