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clinical trajectories, healthcare resource use, and costs of long-term hematopoietic stem cell transplantation survivors: a latent class analysis
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نویسنده
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zhou jifang ,nutescu edith a. ,han jin ,calip gregory s.
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منبع
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journal of cancer survivorship - 2020 - دوره : 14 - شماره : 3 - صفحه:294 -304
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چکیده
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To identify patterns of healthcare utilization in allogeneic and autologous hematopoietic stem cell transplantation (hsct) recipients and evaluate factors associated with high-need and high-cost post-transplantation care. latent class analysis of a retrospective cohort of long-term allogeneic (n = 436) and autologous (n = 888) hsct survivors within the truven marketscan database (2009–2014). we assessed factors associated with the latent classes by comparing post-transplantation healthcare utilization including inpatient admissions and length of stay, emergency room visits, specialist visits, and primary care provider visits. four utilization classes were identified in allogeneic and autologous hsct recipients: (i) outpatient specialist care dominant (51.8% and 57.3%), (ii) outpatient primary care dominant (10.3% and 25.7%), (iii) outpatient/inpatient balanced (20.6% and 13.5%), and (iv) inpatient dominant (17.2% and 3.5%). mean monthly healthcare expenditures in the inpatient dominant utilization class were $41,097 and $25,556 for allogeneic and autologous survivors, respectively, which were two to five times higher compared with other classes during the 2-year post-transplantation period. factors associated with the high utilization class were transfusion (or = 1.87, 95% ci 1.06–3.30) and 100-day post-transplant graft-versus-host-disease (or = 1.76, 95% ci 1.05–2.94) in allogeneic hsct; higher baseline charlson comorbidity index (or = 1.45, 95% ci 1.19–1.76) in autologous hsct. based on distinct patterns of healthcare utilization following hsct, we identified factors associated with higher resource utilization and greater healthcare related expenditures. earlier identification of high-cost and high-need hsct long-term survivors could pave the way for clinicians to offer more continuous engagement in survivorship care delivery.
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کلیدواژه
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hematopoietic stem cell transplantation ,acute care use ,care management ,latent class analysis
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آدرس
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university of illinois at chicago, center for pharmacoepidemiology and pharmacoeconomic research, department of pharmacy systems, usa, university of illinois at chicago, center for pharmacoepidemiology and pharmacoeconomic research, department of pharmacy systems, usa, university of illinois at chicago, center for pharmacoepidemiology and pharmacoeconomic research, comprehensive sickle cell center, department of pharmacy practice, section of hematology/oncology, department of medicine, usa, university of illinois at chicago, center for pharmacoepidemiology and pharmacoeconomic research, department of pharmacy systems, usa. fred hutchinson cancer research center, division of public health sciences, epidemiology program, usa
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Authors
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