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预测德克萨斯州高成本,商业保险的糖尿病患者:特征,医疗利用模式和城乡比较
Lixian Zhong1,2,3, Yidan Huyan4, Elena Andreyeva5
1Irma Lerma Rangel College of Pharmacy, Texas A&M University, College Station, TX, USA.
一小群2型糖尿病患者驱动大部分医疗保健费用. 识别这些高成本用户及其相关的慢性疾病是减少整体医疗保健支出和改善结果的关键.
科学领域:
- 卫生经济学 卫生经济学
- 慢性疾病管理 慢性疾病管理
- 医疗保健服务研究 医疗服务研究
背景情况:
- 2型糖尿病 (T2DM) 是美国普遍存在的一种慢性疾病.
- 一小部分T2DM患者消耗了不成比例的医疗保健资源.
- 早期发现和管理高成本用户可以降低医疗保健支出并改善患者的治疗结果.
研究的目的:
- 分析德克萨斯州商业保险T2DM患者的医疗利用和成本.
- 在这个群体中确定高成本T2DM用户的预测因素.
主要方法:
- 从大型商业保险计划 (2016-2019) 中分析索赔数据.
- 根据12个月的时间,将患者分为前20% (高成本) 和底80% (低成本) 的用户群体.
- 描述性分析和多变量物流回归以确定高成本用户预测因素.
主要成果:
- 高成本使用者的前20%占总医疗费用的83%,平均为41,370美元与2064美元.
- 多种慢性疾病是高医疗成本的重要预测因素.
- 农村高成本用户的使用模式与城市同行有所不同 (医疗专家访问较少,住院住院较多).
结论:
- 在商业保险T2DM个人中,医疗保健的使用和支出遵循了80-20的分布.
- 高成本的T2DM使用者表现出较差的健康状况.
- 虽然农村本身不是高成本的预测因素,但在城市和农村高成本用户之间,利用模式有所不同.
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