Using case-mixes to understand health resource utilization trajectories among older adults at high risk of falls

Introduction: Case-mix classifications of health resource utilization categorize individuals based on their health resource utilization patterns. Cost trajectories (and hence case-mixes) among fallers are not yet established. Examining whether case-mixes exist, based on health care resource use trajectories, will provide novel insight into cost-use patterns of older adults at high-risk of falls. Hence, we identified distinct case-mixes among older fallers determined by their longitudinal health resource utilization (HRU) cost trajectories and outlined baseline predictors of these HRU case-mixes.

Methods: This was a secondary analysis of 343 older community-dwelling adults at high risk of falls who participated in a randomized controlled trial. All participants received baseline best-practice, evidence-based care for falls prevention at the Falls Prevention Clinic. Our main outcomes measures were total healthcare resource utilization costs that were collected prospectively over 12 months using a self-report questionnaire and monthly cost diaries. Case-mixes were visually defined using 12-month longitudinal trajectories and identified with latent class growth modeling. Baseline predictors 1) intervention group; 2) age; 3) biological sex; 4) cognitive function; or 5) physical function of cost trajectories were examined.

Results: We identified 2 distinct case-mixes.  The “low-cost, stable” was characterized by a low baseline HRU (~$500 CAD), which was stable across 12 months. The “low-cost, decreasing” was characterized by the lowest baseline HRU (i.e., <$500 CAD) and decreased over 12 months. Biological sex moderated the trajectories. Specifically, males in the “low-cost, stable” case-mix decreased HRU over 12 months, while female HRU did not change. For the “low-cost, decreasing” case-mix, female HRU decreased at a greater rate over 12 months than for males.

Conclusion: Individuals at high risk of falls who receive baseline Falls Prevention Clinic care demonstrate low patterns of health resource utilization characterized by distinct case-mixes (stable and decreasing health resource use), lending initial support for a Falls Prevention Clinic-based model of care.