Comparisons of medical utilizations and categorical diagnoses of emergency visits between the elderly with catastrophic illness certificates and those without

Abstract

BackgroundIn Taiwan, the policy of catastrophic illness certificates has benefited some populations with specific diseases, but its effect on the use of medical services and the sequence of public health has not been examined. As a pilot of a series of studies, focused on emergency department (ED) visits, the present study aimed to compare medical utilization and various diagnostic categories at EDs between the elderly with an identified catastrophic illness and the elderly without.MethodsA cross-sectional study, based on a large-sample nationwide database (one million of the population, randomly sampled from Taiwan’s National Health Insurance Research Database (NHIRD)), was performed in Taiwan. The 2008 insurance records of ambulatory medical services for subjects aged 65 years or more among the above one million of the population were further selected and analyzed. Taiwan’s registered catastrophic illness dataset for 2008 was linked in order to identify the target subgroup.ResultsThe prevalence of certificated catastrophic illness in Taiwan’s elderly utilizing ambulatory medical services was 10.16%. On average, 61.62 emergency department (ED) visits/1,000 persons (95% CI: 59.22–64.01) per month was estimated for the elderly Taiwanese with catastrophic illness, which was significantly greater than that for the elderly without a catastrophic illness (mean 33.53, 95% CI: 32.34–34.71). A significantly greater total medical expenditure for emergency care was observed in the catastrophic illness subgroup (US$145.6 ± 193.5) as compared with the non-catastrophic illness group (US$108.7 ± 338.0) (p < 0.001). The three most common medical problems diagnosed when visiting EDs were injury/poisoning (14.22%), genitourinary disorders (11.26%) and neoplasm-related morbidity (10.77%) for the elderly population with a catastrophic illness, which differed from those for the elderly without a catastrophic illness.ConclusionsIn Taiwan, the elderly with any certificated catastrophic illness had significantly more ED visits and a higher ED medical cost due to untypical medical complaints.

Long‐Term Effects of Unprovoked Venous Thromboembolism on Mortality and Major Cardiovascular Events

“…The Longitudinal Health Insurance Database 2000 provides encrypted patient identification numbers, sex, date of birth, dates of admission and discharge, the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD‐9‐CM) codes of diagnoses and procedures, details of prescriptions, registry in the Catastrophic Illness Patient Database, and costs covered and paid for by the NHI. The National Health Insurance Research Database has been described in detail in previous studies . The accuracy of diagnosis of major diseases in the National Health Insurance Research Database, such as stroke and acute coronary syndrome, has been validated .…”

“…The National Health Insurance Research Database has been described in detail in previous studies . The accuracy of diagnosis of major diseases in the National Health Insurance Research Database, such as stroke and acute coronary syndrome, has been validated . This study was exempt from full review by the institutional review board of Chi‐Mei Hospital (CV code: 10406‐E01).…”

“…To specifically select patients with unprovoked VTE at the time of initial enrollment, we excluded patients diagnosed with malignant cancer (ICD‐9 codes 140–208, concomitantly registered with catastrophic illness), autoimmune diseases (ICD‐9 codes 696.0, 696.1, 696.8, 710.0, 710.1, 710.2, 710.3, 710.4, and 714.0), or iatrogenic pulmonary embolism and infarction (ICD‐9 codes 415.11). Notably, because the issue of catastrophic illness is associated with the payment of the NHI, the coding of cancer and autoimmune diseases are validated to achieve a high accuracy . We also excluded patients who were pregnant at the time of enrollment (ICD‐9 codes 671.3, 671.4, 673, and 673.2) or were immobilized anytime during the 3 months before diagnosis owing to major surgeries or systemic diseases (ICD‐9 codes 820–823, procedure code 81.51, 81.52, 81.53, and 81.54).…”

What's cost got to do with it? Association between hospital costs and frequency of admissions among “high users” of hospital care

“…5 As such, hospitals are increasingly focusing on implementing interventions to reduce rates of hospitalizations and readmissions as a mechanism to reduce overall healthcare costs. [5][6][7][8][9] Multiple factors potentially contribute to patients being "high cost," including acute care utilization, [10][11][12] pharmaceuticals, 13,14 procedures, 15 catastrophic illness, 16 and high-risk chronic conditions. 11,17,18 How-ever, many hospitals are implementing interventions focused on a single subset of these high cost patientshigh users of inpatient services.…”

Does Compulsory Admission Prevent Inpatient Suicide Among Patients with Schizophrenia? A Nationwide Cohort Study in Taiwan

“…The NHIRD includes several diseases or injuries as catastrophic illnesses, including schizophrenia, malignant neoplasms, systemic lupus erythematous, and burns affecting >20% of the total body surface (Nan‐Ping et al., ). Suicide history indicates that an individual has made a suicide attempt up to 1 year before the index date.…”