Chronic illness and serial hospitalizations: An empirical investigation of a hidden phenomenon in the health care system

The acute care paradigm, with the single hospitalization as the unit of intervention and analysis, is no longer an appropriate model for the behavior of many patients. This study established that much of the chronically ill\u27s inpatient hospital utilization can be meaningfully redefined to a chronic disease paradigm. The concept used is the Disease Career : an individuals\u27 series of hospital stays for one or more underlying chronic illness as over a defined time period. Using a Disease Staging-based methodology, 65 Disease Careers (repeated hospitalizations for the same disease) could be defined from a population of 9,129 patients aged 44 years and over with two or more hospital stays during 1979-1983. Approximately, 40% of the sample could be classified into a Disease Career/Career Group. The remainder were defined as Multiple Disease Careers. Setwise Ordinary Least Squares multiple regression was performed to understand the relationships of casemix variables to each Career Behavior dependent variable and identify the Career Diseases that could be differentiated from the Multiple Disease Career based on Career Behavior differences. Career Disease specification was viable concept analytically; representing a significant improvement in explanation of variations in Career Behavior variables over casemix measures. A number of Career Diseases were distinguishable from the general Multiple Disease Career on the basis of expressed Career Behavior differences. There was a strong relationship between Severity and Career Behavior that was generally not large and therefore of less substantive importance. Age was the sole demographic variable of importance. Sex and Race were generally unimportant. Career Outcome was the most critical factor in Career Behavior, often transcending disease identity. The primary impact of decendent Outcome was on Career costs. The sources of the differential were increased hospitalizations, higher ancillaries, increased use of Intensive Care/other Special Care Units and greater hospital days. Two general modes of high cost Disease Careers were identified. High cost/high intensity diseases had high ancillary levels. Circulatory System diseases were examples. High cost/low intensity diseases achieved status primarily through inpatient days, whether due to high recidivism or long stays. These diseases included most Cancers, Musculoskeletal Disease Diabetes, Gastrointestinal Diseases, Vertebral Artery Disease and Chronic Obstructive Pulmonary Disease