{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T00:23:51Z","timestamp":1792801431691,"version":"4.5.0"},"reference-count":35,"publisher":"BMJ","issue":"4","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2015,3,18]]},"published-print":{"date-parts":[[2015,4]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To investigate the relationship between multimorbidity and healthcare utilisation patterns among the highest cost patients in a large, integrated healthcare system.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>In this retrospective cross-sectional study of all patients in the U.S. Veterans Affairs (VA) Health Care System, we aggregated costs of individuals\u2019 outpatient and inpatient care, pharmacy services and VA-sponsored contract care received in 2010. We assessed chronic condition prevalence, multimorbidity as measured by comorbidity count, and multisystem multimorbidity (number of body systems affected by chronic conditions) among the 5% highest cost patients. Using multivariate regression, we examined the association between multimorbidity and healthcare utilisation and costs, adjusting for age, sex, race\/ethnicity, marital status, homelessness and health insurance status.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>USA VA Health Care System.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>5.2 million VA patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measures<\/jats:title>\n                    <jats:p>Annual total costs; absolute and share of costs generated through outpatient, inpatient, pharmacy and VA-sponsored contract care; number of visits to primary, specialty and mental healthcare; number of emergency department visits and hospitalisations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The 5% highest cost patients (n=261\u2005699) accounted for 47% of total VA costs. Approximately two-thirds of these patients had chronic conditions affecting \u22653 body systems. Patients with cancer and schizophrenia were less likely to have documented comorbid conditions than other high-cost patients. Multimorbidity was generally associated with greater outpatient and inpatient utilisation. However, increased multisystem multimorbidity was associated with a higher outpatient share of total costs (1.6 percentage points per affected body system, p&lt;0.01) but a lower inpatient share of total costs (\u22120.6 percentage points per affected body system, p&lt;0.01).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Multisystem multimorbidity is common among high-cost VA patients. While some patients might benefit from disease-specific programmes, for most patients with multimorbidity there is a need for interventions that coordinate and maximise efficiency of outpatient services across multiple conditions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2015-007771","type":"journal-article","created":{"date-parts":[[2015,4,16]],"date-time":"2015-04-16T22:52:22Z","timestamp":1429224742000},"page":"e007771","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":202,"title":["Multimorbidity and healthcare utilisation among high-cost patients in the US Veterans Affairs Health Care System"],"prefix":"10.1136","volume":"5","author":[{"given":"Donna M","family":"Zulman","sequence":"first","affiliation":[{"name":"Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, California, USA"},{"name":"Division of General Medical Disciplines, Stanford University, Stanford, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine","family":"Pal Chee","sequence":"additional","affiliation":[{"name":"Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, California, USA"},{"name":"Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Todd H","family":"Wagner","sequence":"additional","affiliation":[{"name":"Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, California, USA"},{"name":"Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park, California, USA"},{"name":"Health Research and Policy, Stanford University, Stanford, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean","family":"Yoon","sequence":"additional","affiliation":[{"name":"Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, California, USA"},{"name":"Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danielle M","family":"Cohen","sequence":"additional","affiliation":[{"name":"Division of General Medical Disciplines, Stanford University, Stanford, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tyson H","family":"Holmes","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine","family":"Ritchie","sequence":"additional","affiliation":[{"name":"Division of Geriatrics, University of California, San Francisco, California, USA"},{"name":"San Francisco VA Medical Center, San Francisco, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven M","family":"Asch","sequence":"additional","affiliation":[{"name":"Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, California, USA"},{"name":"Division of General Medical Disciplines, Stanford University, Stanford, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2015,4,16]]},"reference":[{"key":"2025121222085401000_5.4.e007771.1","unstructured":"Cohen S , Uberoi N . 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