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What can five high cost patients teach us about healthcare spending?

机译：五个高成本患者可以教我们关于医疗保健支出的内容？

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The highest cost patients account for a disproportionately large share of American healthcare costs and are increasingly the focus of research and policy efforts to stem the rapid growth of these costs. These patients tend to be medically complex and frail, but we know little about how such characteristics influence healthcare spending from the perspectives of the patients and their caregivers. Therefore, we examined five of the highest cost patients at an academic medical center in a case series. We interviewed the patients, their family members, and their clinicians and analyzed their claims data and medical charts to explore how patient and health system characteristics influenced their health costs. We found that their complex medical issues, physical disability/ frailty, and mental illness/substance use seemed to be linked with increased costs, while their socioeconomic status, social network, activation, and trust in clinicians and the health system appeared to increase or decrease costs depending on context. In these patients' narratives, trust seemed to modify the interaction between patient activation and cost. Our observations raise questions about whether factors mediating costs in high-cost patients may be more heterogenous than previously described and if patient trust and activation may be important, potentially modifiable drivers of these costs. Our case series illustrates the challenges of unilateral policies to address high cost patients and the need for targeted approaches.
机译：成本最高的患者在美国医疗保健成本中所占比例过高，并且越来越成为遏制这些成本快速增长的研究和政策努力的重点。这些患者往往身体复杂、虚弱，但从患者及其护理者的角度来看，我们对这些特征如何影响医疗支出知之甚少。因此，我们在一个学术医疗中心对五名费用最高的患者进行了病例系列研究。我们采访了患者、他们的家人和临床医生，分析了他们的索赔数据和医疗图表，以探索患者和医疗系统特征如何影响他们的医疗成本。我们发现，他们复杂的医疗问题、身体残疾/虚弱、精神疾病/药物使用似乎与成本增加有关，而他们的社会经济地位、社会网络、活跃度以及对临床医生和卫生系统的信任似乎会根据具体情况增加或减少成本。在这些患者的叙述中，信任似乎改变了患者激活和成本之间的相互作用。我们的观察结果提出了这样一个问题：在高成本患者中，调节成本的因素是否比之前描述的更为异质，以及患者的信任和激活是否重要，这些成本的潜在可调整驱动因素。我们的案例系列说明了解决高成本患者的单边政策的挑战，以及有针对性的方法的必要性。

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