Health outcomes and cost of care among older adults with schizophrenia

A 10-year study using medical records across the continuum of care

Hugh Hendrie, Wanzhu Tu, Rebeka Tabbey, Christianna E. Purnell, Roberta J. Ambuehl, Christopher Callahan

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Objectives: The population of older patients with schizophrenia is increasing. This study describes health outcomes, utilization, and costs over 10 years in a sample of older patients with schizophrenia compared with older patients without schizophrenia. Methods: An observational cohort study of 31,588 older adults (mean age: 70.44 years) receiving care from an urban public health system, including a community mental health center, during 1999-2008. Of these, 1,635 (5.2%) were diagnosed with schizophrenia and 757 (2.4%) had this diagnosis confirmed in the community mental health center. Patients' electronic medical records were merged with Medicare claims, Medicaid claims, the Minimum Dataset, and the Outcome and Assessment Information Set. Information on medication use was not available. Measurements: Rates of comorbid conditions, healthcare utilization, costs, and mortality. Results: Patients with schizophrenia had significantly higher rates of congestive heart failure (45.05% versus 38.84%), chronic obstructive pulmonary disease (52.71% versus 41.41%), and hypothyroidism (36.72% versus 26.73%) than the patients without schizophrenia (p <0.001). They had significantly lower rates of cancer (30.78% versus 43.18%) and significantly higher rates of dementia (64.46% versus 32.13%). The patients with schizophrenia had significantly higher mortality risk (hazard ratio: 1.25, 95% confidence interval: 1.07-1.47) than the patients without schizophrenia. They also had significantly higher rates of healthcare utilization. The mean costs for Medicare and Medicaid were significantly higher for the patients with schizophrenia than for the patients without schizophrenia. Conclusions: The management of older adult patients with schizophrenia is creating a serious burden for our healthcare system, requiring the development of integrated models of healthcare.

Original languageEnglish
Pages (from-to)427-436
Number of pages10
JournalAmerican Journal of Geriatric Psychiatry
Volume22
Issue number5
DOIs
StatePublished - 2014

Fingerprint

Continuity of Patient Care
antineoplaston A10
Health Care Costs
Medical Records
Schizophrenia
Community Mental Health Centers
Medicaid
Medicare
Delivery of Health Care
Urban Health
Costs and Cost Analysis
Mortality
Electronic Health Records
Hypothyroidism
Chronic Obstructive Pulmonary Disease
Observational Studies
Dementia
Cohort Studies
Heart Failure
Public Health

Keywords

  • Cancer
  • Comorbidity
  • Dementia
  • Hospital care
  • Mortality
  • Nursing home

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Geriatrics and Gerontology
  • Medicine(all)

Cite this

Health outcomes and cost of care among older adults with schizophrenia : A 10-year study using medical records across the continuum of care. / Hendrie, Hugh; Tu, Wanzhu; Tabbey, Rebeka; Purnell, Christianna E.; Ambuehl, Roberta J.; Callahan, Christopher.

In: American Journal of Geriatric Psychiatry, Vol. 22, No. 5, 2014, p. 427-436.

Research output: Contribution to journalArticle

@article{ff7e78fd2d8246f0b6e2ce7abc22988a,
title = "Health outcomes and cost of care among older adults with schizophrenia: A 10-year study using medical records across the continuum of care",
abstract = "Objectives: The population of older patients with schizophrenia is increasing. This study describes health outcomes, utilization, and costs over 10 years in a sample of older patients with schizophrenia compared with older patients without schizophrenia. Methods: An observational cohort study of 31,588 older adults (mean age: 70.44 years) receiving care from an urban public health system, including a community mental health center, during 1999-2008. Of these, 1,635 (5.2{\%}) were diagnosed with schizophrenia and 757 (2.4{\%}) had this diagnosis confirmed in the community mental health center. Patients' electronic medical records were merged with Medicare claims, Medicaid claims, the Minimum Dataset, and the Outcome and Assessment Information Set. Information on medication use was not available. Measurements: Rates of comorbid conditions, healthcare utilization, costs, and mortality. Results: Patients with schizophrenia had significantly higher rates of congestive heart failure (45.05{\%} versus 38.84{\%}), chronic obstructive pulmonary disease (52.71{\%} versus 41.41{\%}), and hypothyroidism (36.72{\%} versus 26.73{\%}) than the patients without schizophrenia (p <0.001). They had significantly lower rates of cancer (30.78{\%} versus 43.18{\%}) and significantly higher rates of dementia (64.46{\%} versus 32.13{\%}). The patients with schizophrenia had significantly higher mortality risk (hazard ratio: 1.25, 95{\%} confidence interval: 1.07-1.47) than the patients without schizophrenia. They also had significantly higher rates of healthcare utilization. The mean costs for Medicare and Medicaid were significantly higher for the patients with schizophrenia than for the patients without schizophrenia. Conclusions: The management of older adult patients with schizophrenia is creating a serious burden for our healthcare system, requiring the development of integrated models of healthcare.",
keywords = "Cancer, Comorbidity, Dementia, Hospital care, Mortality, Nursing home",
author = "Hugh Hendrie and Wanzhu Tu and Rebeka Tabbey and Purnell, {Christianna E.} and Ambuehl, {Roberta J.} and Christopher Callahan",
year = "2014",
doi = "10.1016/j.jagp.2012.10.025",
language = "English",
volume = "22",
pages = "427--436",
journal = "American Journal of Geriatric Psychiatry",
issn = "1064-7481",
publisher = "Lippincott Williams and Wilkins",
number = "5",

}

TY - JOUR

T1 - Health outcomes and cost of care among older adults with schizophrenia

T2 - A 10-year study using medical records across the continuum of care

AU - Hendrie, Hugh

AU - Tu, Wanzhu

AU - Tabbey, Rebeka

AU - Purnell, Christianna E.

AU - Ambuehl, Roberta J.

AU - Callahan, Christopher

PY - 2014

Y1 - 2014

N2 - Objectives: The population of older patients with schizophrenia is increasing. This study describes health outcomes, utilization, and costs over 10 years in a sample of older patients with schizophrenia compared with older patients without schizophrenia. Methods: An observational cohort study of 31,588 older adults (mean age: 70.44 years) receiving care from an urban public health system, including a community mental health center, during 1999-2008. Of these, 1,635 (5.2%) were diagnosed with schizophrenia and 757 (2.4%) had this diagnosis confirmed in the community mental health center. Patients' electronic medical records were merged with Medicare claims, Medicaid claims, the Minimum Dataset, and the Outcome and Assessment Information Set. Information on medication use was not available. Measurements: Rates of comorbid conditions, healthcare utilization, costs, and mortality. Results: Patients with schizophrenia had significantly higher rates of congestive heart failure (45.05% versus 38.84%), chronic obstructive pulmonary disease (52.71% versus 41.41%), and hypothyroidism (36.72% versus 26.73%) than the patients without schizophrenia (p <0.001). They had significantly lower rates of cancer (30.78% versus 43.18%) and significantly higher rates of dementia (64.46% versus 32.13%). The patients with schizophrenia had significantly higher mortality risk (hazard ratio: 1.25, 95% confidence interval: 1.07-1.47) than the patients without schizophrenia. They also had significantly higher rates of healthcare utilization. The mean costs for Medicare and Medicaid were significantly higher for the patients with schizophrenia than for the patients without schizophrenia. Conclusions: The management of older adult patients with schizophrenia is creating a serious burden for our healthcare system, requiring the development of integrated models of healthcare.

AB - Objectives: The population of older patients with schizophrenia is increasing. This study describes health outcomes, utilization, and costs over 10 years in a sample of older patients with schizophrenia compared with older patients without schizophrenia. Methods: An observational cohort study of 31,588 older adults (mean age: 70.44 years) receiving care from an urban public health system, including a community mental health center, during 1999-2008. Of these, 1,635 (5.2%) were diagnosed with schizophrenia and 757 (2.4%) had this diagnosis confirmed in the community mental health center. Patients' electronic medical records were merged with Medicare claims, Medicaid claims, the Minimum Dataset, and the Outcome and Assessment Information Set. Information on medication use was not available. Measurements: Rates of comorbid conditions, healthcare utilization, costs, and mortality. Results: Patients with schizophrenia had significantly higher rates of congestive heart failure (45.05% versus 38.84%), chronic obstructive pulmonary disease (52.71% versus 41.41%), and hypothyroidism (36.72% versus 26.73%) than the patients without schizophrenia (p <0.001). They had significantly lower rates of cancer (30.78% versus 43.18%) and significantly higher rates of dementia (64.46% versus 32.13%). The patients with schizophrenia had significantly higher mortality risk (hazard ratio: 1.25, 95% confidence interval: 1.07-1.47) than the patients without schizophrenia. They also had significantly higher rates of healthcare utilization. The mean costs for Medicare and Medicaid were significantly higher for the patients with schizophrenia than for the patients without schizophrenia. Conclusions: The management of older adult patients with schizophrenia is creating a serious burden for our healthcare system, requiring the development of integrated models of healthcare.

KW - Cancer

KW - Comorbidity

KW - Dementia

KW - Hospital care

KW - Mortality

KW - Nursing home

UR - http://www.scopus.com/inward/record.url?scp=84901411289&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84901411289&partnerID=8YFLogxK

U2 - 10.1016/j.jagp.2012.10.025

DO - 10.1016/j.jagp.2012.10.025

M3 - Article

VL - 22

SP - 427

EP - 436

JO - American Journal of Geriatric Psychiatry

JF - American Journal of Geriatric Psychiatry

SN - 1064-7481

IS - 5

ER -