Using case-mixes to understand health resource utilization trajectories among older adults at high risk of falls who received baseline geriatrician-based Falls Prevention Clinic care.

backgroundWe identified case-mixes among older adults at high risk of future falls, determined by longitudinal health resource utilization (HRU) cost trajectories, and examined baseline characteristics associated with these trajectories.

methodsThis descriptive secondary cohort analysis included 343 community-dwelling older adults at high risk of falls who participated in a randomized controlled trial. All participants received evidence-based falls prevention care at the Falls Prevention Clinic. The primary outcome was total healthcare resource utilization costs collected prospectively over 12 months using self-report questionnaires and monthly cost diaries. Case-mixes were identified using 12-month trajectories and latent class growth modeling. Baseline characteristics examined included intervention group, age, biological sex, cognitive function, and physical function.

resultsWe identified 2 case-mixes. The "low-cost, stable" case-mix was characterized by low baseline HRU (∼$500 CAD) that remained stable over 12 months. The "low-cost, decreasing" case-mix had the lowest baseline HRU (<$500 CAD) and decreased over 12 months. Biological sex modified the trajectories. Specifically, males in the "low-cost, stable" case-mix demonstrated decreased HRU over 12 months, whereas female HRU remained unchanged. In the "low-cost, decreasing" case-mix, female HRU decreased at a greater rate than male HRU.

conclusionsOlder adults at high risk of falls receiving Falls Prevention Clinic care demonstrated relatively low HRU characterized by stable and decreasing case-mixes. These findings provide descriptive insight into healthcare utilization patterns and may inform future evaluations of Falls Prevention Clinic models of care. These findings may assist future risk stratification and healthcare planning for older adults at elevated falls risk internationally.The trial was registered at clinicaltrials.gov (NCT01029171; NCT00323596).