TY - JOUR
T1 - Health service utilization patterns among adults with congenital heart disease
T2 - A population-based study
AU - Benderly, Michal
AU - Buber, Jonathan
AU - Kalter-Leibovici, Ofra
AU - Blieden, Leonard
AU - Dadashev, Alexander
AU - Lorber, Avraham
AU - Nir, Amiram
AU - Yalonetsky, Sergei
AU - Chodick, Gabriel
AU - Weitzman, Dahlia
AU - Balicer, Ran
AU - Dray, Efrat Mazor
AU - Murad, Havi
AU - Razon, Yaron
AU - Hirsch, Rafael
AU - Benderly, Michal
AU - Buber, Jonathan
AU - Blieden, Leonard
AU - Dadashev, Alexander
AU - Lorber, Avraham
AU - Nir, Amiram
AU - Mazor, Efrat
AU - Razon, Yaron
N1 - Publisher Copyright:
© 2021 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
PY - 2021/1/19
Y1 - 2021/1/19
N2 - BACKGROUND: Several studies have examined hospitalizations among patients with adult congenital heart disease (ACHD). Few investigated other services or utilization patterns. Our aim was to study service utilization patterns and predictors among patients with ACHD. METHODS AND RESULTS: We identified 11 653 patients with ACHD aged >18 years (median, 47 years), through electronic re-cords of 2 large Israeli healthcare providers (2007-2011). The association between patient, disease, and sociogeographic characteristics and healthcare resource utilization were modeled as recurrent events accounting for the competing death risk. Patients with ACHD had high healthcare utilization rates compared with the general population. The highest standard-ized service utilization ratios (SSRs) were found among patients with complex congenital heart disease including primary care visits (SSR, 1.53; 95% CI, 1.47-1.58), cardiology outpatient visits (SSR, 5.17; 95% CI, 4.69-5.64), hospitalizations (SSR, 6.68; 95% CI, 5.82-7.54), and days in hospital (SSR, 15.37; 95% CI, 14.61-16.12). Adjusted resource utilization hazard increased with increasing lesion complexity. Hazard ratios (HRs) for complex versus simple disease were: Primary care (HR, 1.14; 95% CI, 1.06-1.23); cardiology outpatient visits (HR, 1.40; 95% CI, 1.24-1.59); emergency department visits (HR, 1.19; 95% CI, 1.02-1.39); and hospitalizations (HR, 1.75; 95% CI, 1.49-2.05). Effects attenuated with age for cardiology outpatient visits and hospitalizations and increased for emergency department visits. Female sex, geographic periphery, and ethnic minority were associated with more primary care visits, and female sex (HR versus men, 0.89 [95% CI, 0.84-0.94]) and periphery (HR, 0.72 [95% CI, 0.58-0.90] for very peripheral versus very central) were associated with fewer cardiology visits. Arab minority patients also had high hospitalization rates compared with the majority group of Jewish or other patients. CONCLUSIONS: Healthcare utilization rates were high among patients with ACHD. Female sex, geographic periphery, and eth-nicity were associated with less optimal service utilization patterns. Further research should examine strategies to optimize service utilization in these groups.
AB - BACKGROUND: Several studies have examined hospitalizations among patients with adult congenital heart disease (ACHD). Few investigated other services or utilization patterns. Our aim was to study service utilization patterns and predictors among patients with ACHD. METHODS AND RESULTS: We identified 11 653 patients with ACHD aged >18 years (median, 47 years), through electronic re-cords of 2 large Israeli healthcare providers (2007-2011). The association between patient, disease, and sociogeographic characteristics and healthcare resource utilization were modeled as recurrent events accounting for the competing death risk. Patients with ACHD had high healthcare utilization rates compared with the general population. The highest standard-ized service utilization ratios (SSRs) were found among patients with complex congenital heart disease including primary care visits (SSR, 1.53; 95% CI, 1.47-1.58), cardiology outpatient visits (SSR, 5.17; 95% CI, 4.69-5.64), hospitalizations (SSR, 6.68; 95% CI, 5.82-7.54), and days in hospital (SSR, 15.37; 95% CI, 14.61-16.12). Adjusted resource utilization hazard increased with increasing lesion complexity. Hazard ratios (HRs) for complex versus simple disease were: Primary care (HR, 1.14; 95% CI, 1.06-1.23); cardiology outpatient visits (HR, 1.40; 95% CI, 1.24-1.59); emergency department visits (HR, 1.19; 95% CI, 1.02-1.39); and hospitalizations (HR, 1.75; 95% CI, 1.49-2.05). Effects attenuated with age for cardiology outpatient visits and hospitalizations and increased for emergency department visits. Female sex, geographic periphery, and ethnic minority were associated with more primary care visits, and female sex (HR versus men, 0.89 [95% CI, 0.84-0.94]) and periphery (HR, 0.72 [95% CI, 0.58-0.90] for very peripheral versus very central) were associated with fewer cardiology visits. Arab minority patients also had high hospitalization rates compared with the majority group of Jewish or other patients. CONCLUSIONS: Healthcare utilization rates were high among patients with ACHD. Female sex, geographic periphery, and eth-nicity were associated with less optimal service utilization patterns. Further research should examine strategies to optimize service utilization in these groups.
KW - Adult congenital heart disease
KW - Healthcare service utilization
KW - Mortality
KW - Population-based study
UR - http://www.scopus.com/inward/record.url?scp=85100125840&partnerID=8YFLogxK
U2 - 10.1161/JAHA.120.018037
DO - 10.1161/JAHA.120.018037
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C2 - 33432841
AN - SCOPUS:85100125840
SN - 2047-9980
VL - 10
SP - 1
EP - 11
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 2
M1 - e018037
ER -