Association of Depression Risk with Patient Experience, Healthcare Expenditure, and Health Resource Utilization Among Ad
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Department of Internal Medicine, East Carolina University, Greenville, NC, USA; 2Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT, USA; 3Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD, USA; 4Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; 5Baptist Health South Florida, Miami, FL, USA; 6Department of Medicine, St. Luke’s Hospital, Chesterfield, MO, USA; 7Department of Surgery, Wexner Medical Center, Columbus, OH, USA; 8Section of Cardiovascular Medicine, Yale University, New Haven, CT, USA.
BACKGROUND: Approximately 20% of patients with atherosclerotic cardiovascular disease (ASCVD) suffer from depression. OBJECTIVE: To compare healthcare expenditures and utilization, healthcare-related quality of life, and patientcentered outcomes among ASCVD patients, based on their risk for depression (among those without depression), and those with depression (vs. risk-stratified nondepressed). DESIGN AND SETTING: The 2004–2015 Medical Expenditure Panel Survey (MEPS) was used for this study. PARTICIPANTS: Adults ≥ 18 years with a diagnosis of ASCVD, ascertained by ICD-9 codes and/or selfreported data. Individuals with a diagnosis of depression were identified by ICD-9 code 311. Participants were stratified by depression risk, based on the Patient Health Questionnaire-2. RESULTS: A total of 19,840 participants were included, translating into 18.3 million US adults, of which 8.6% (≈ 1.3 million US adults) had a high risk for depression and 18% had a clinical diagnosis of depressi on. Among ASCVD patients without depression, those with a high risk (compared with low risk) had increased overall and out-of-pocket expenditures (marginal differences of $2880 and $287, respectively, both p < 0.001), higher odds for resource utilization, and worse patient experience and healthcare quality of life (HQoL). Furthermore, compared with individuals who had depression, participants at high risk also reported worse HQoL and had higher odds of Victor Okunrintemi and Javier Valero-Elizondo contributed equally to this work. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11606-019-05325-8) contains supplementary material, which is available to authorized users. Received September 19, 2018 Revised March 29, 2019 Accepted August 7, 2019
poor perception of their health status (OR 1.83, 95% CI [1.50, 2.23]) and poor patient-provider communication (OR 1.29 [1.18, 1.42]). LIMITATION: The sample population includes selfreported diagnosis of ASCVD; therefore, the risk of underestimation of the cohort size cannot be ruled out. CONCLUSION: Almost 1 in 10 individuals with ASCVD without diagnosis of depression is at high risk for it and has worse health outcomes compared with those who already have a diagnosis of depression. Early recognition and treatment of depression may increase healthcare efficiency, positive patient experience, and HQoL among this vulnerable population. KEY WORDS: atherosclerotic ca
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