RP #3: Access, utilization and costs of health and social care associated with frailty profiles and their trajectories.
PRINCIPAL INVESTIGATORS: F Béland, N Dubuc , M Rochon
CO-INVESTIGATOR: M Tousignant.
NTRODUCTION: Chronic diseases, disabilities and cognitive problems in elderly persons, and their associated healthcare costs, are concentrated in a relatively small portion of that population. Furthermore, it is the approach of death, and not aging itself, that explains a significant portion of the high cost of healthcare; the older a person is at death, the lower cost of care. The heterogeneity of healthcare costs for elderly persons and how they evolve with increasing age are poorly understood. A better understanding would be of benefit to researchers, clinicians and healthcare planners. Frailty presupposes a complex interaction of the biological, psychological, cognitive and social components that define and explain it. Studies have shown that frailty is associated with increased use and costs of healthcare and social services. This study will consider frailty as one of the principal factors for the increase in the cost of healthcare and social services as people age.
OBJECTIVES: The main objective of this study is to associate frailty with the use and costs of healthcare and social services. The results will help improve the planning of healthcare and social services as well as the programs designed for the frail elderly.
This will be achieved through two specific objectives:
1) Describe the accessibility, use and cost of healthcare and social services for frail elderly over time;
2) Study the correspondence between frailty profiles and trajectories with accessibility, use and costs.
METHODS: The accessibility, use and costs of healthcare and social services for each participant (in the NuAge and CSSS longitudinal studies) will be examined for the entire duration of the data collection. Use and cost data will come from administrative databases (RAMQ, MedÉcho, iCLSC, Urgence Santé, etc.) and patient records (hospitals, CLSC, etc.). Frailty data will be obtained from two samples of elderly persons living in Québec.
Sample 1: Data from the NuAge longitudinal study, which tracks 1763 elderly persons in the Sherbrooke region over three years. Of that group, 1300 consented access to their administrative and medical records. This sample will permit the introduction of biological and physical components of frailty, which are difficult to measure in large representative samples of the elderly population. It will give a complete portrait of the health status of elderly persons for studying the accessibility, use and costs of healthcare and social services.
Sample 2: Three samples from the FRÉLE study that provide an accurate representation of the elderly populations will be used. They include 1600 elderly persons in three CSSS catchment areas, located in metropolitan, urban and semi-urban areas (CSSS Saint-Laurent-Bordeaux-Cartierville in Montréal, CSSS Institut universitaire de gériatrie de Sherbrooke [CSSS-IUGS] and CSSS Des Érables, respectively).
ACCESSIBILITY, USE AND COST MEASUREMENTS: Healthcare and social services mean the entirety of the public services used by the frail elderly. Accessibility, use and costs will be assessed. Accessibility is a binary parameter – an elderly person either does or does not have access to a service. Use is a measure of intensity. It is derived from the number of doctor visits, length of hospitalization, number of hours spent in emergency and the number of hours of homecare nursing and social services used. Costs are based on the intensity of services used, weighted by unit of cost.
STATISTICAL PROCEDURES: Accessibility, use and cost data will be grouped into three aggregation levels. At the top level, only costs will be considered to determine total costs. The second level will estimate accessibility, use and costs of institutional services on the one hand and local services on the other. At the third level, accessibility, use and costs of the most frequently used services (hospitalization and intensive care, emergency department visits, institutionalized nursing care, homecare nursing and social services, drug prescriptions and visits to family physicians or specialists) will be linked to frailty profiles and trajectories.
CONFIDENTIALITY: Information will be kept in locked filing cabinets inside a locked room. Data will also be modified to be completely anonymous.
TYPE OF RESEARCH: This is a secondary study. Only participants who have given consent for their social insurance number to be used to examine their administrative and medical records can be included in this study.
EXPECTED RESULTS: The contribution of frailty to the total costs of healthcare and social services and the individual costs of institutional or community services or extended care will be established. The manner in which accessibility, use and costs evolve as the frailty of elderly persons changes will be available to our partners for planning care services for this part of the population.