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Senior high-cost healthcare users’ resource utilization and outcomes: a protocol of a retrospective matched cohort study in Canada
  1. Sergei Muratov1,2,
  2. Justin Lee1,3,4,5,
  3. Anne Holbrook1,4,
  4. J Michael Paterson6,
  5. Jason Robert Guertin7,8,
  6. Lawrence Mbuagbaw1,
  7. Tara Gomes6,9,
  8. Wayne Khuu6,
  9. Priscila Pequeno6,
  10. Andrew P Costa1,10,
  11. Jean-Eric Tarride1,2,11
  1. 1Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
  2. 2Programs for Assessment of Technology in Health (PATH), The Research Institute of St. Joe’s Hamilton, St. Joseph’s Healthcare, Hamilton, Ontario, Canada
  3. 3Division of Geriatric Medicine, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
  4. 4Division of Clinical Pharmacology and Toxicology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
  5. 5Geriatric Education and Research in Aging Sciences Centre, Hamilton Health Sciences, Hamilton, Ontario, Canada
  6. 6Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada
  7. 7Département de médecine sociale et préventive, Faculté de Médecine, Université Laval, Quebec City, Quebec, Canada
  8. 8Centre de recherche du CHU de Québec, Université Laval, Axe Santé des Populations et Pratiques Optimales en Santé, Quebec City, Quebec, Canada
  9. 9Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
  10. 10Big Data and Geriatric Models of Care Cluster, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
  11. 11Center for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Ontario, Canada
  1. Correspondence to Mr. Sergei Muratov; muratos{at}


Introduction Senior high-cost users (HCUs) are estimated to represent 60% of all HCUs in Ontario, Canada’s most populous province. To improve our understanding of individual and health system characteristics related to senior HCUs, we will examine incident senior HCUs to determine their incremental healthcare utilisation and costs, characteristics of index hospitalisation episodes, mortality and their regional variation across Ontario.

Methods and analysis A retrospective, population-based cohort study using administrative healthcare records will be used. Incident senior HCUs will be defined as Ontarians aged ≥66 years who were in the top 5% of healthcare cost users during fiscal year 2013 but not during fiscal year 2012. Each HCU will be matched to three non-HCUs by age, sex and health planning region. Incremental healthcare use and costs will be determined using the method of recycled predictions. We will apply multivariable logistic regression to determine patient and health service factors associated with index hospitalisation and inhospital mortality during the incident year. The most common causes of admission will be identified and contrasted with the most expensive hospitalised conditions. We will also calculate the ratio of inpatient costs incurred through admissions of ambulatory care sensitive conditions to the total inpatient expenditures. The magnitude of variation in costs and health service utilisation will be established by calculating the extremal quotient, the coefficient of variation and the Gini mean difference for estimates obtained through multilevel regression analyses.

Ethics and dissemination This study has been approved by Hamilton Integrated Research Ethics Board (ID#1715-C). The results of the study will be distributed through peer-reviewed journals. They also will be disseminated at research events in academic settings, national and international conferences as well as with presentations to provincial health authorities.

  • health economics
  • health services administration and management
  • geriatrics medicine

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

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  • Contributors SM, J-ET, AH, JL, JMP, TG and JRG conceptualised the study. All authors have contributed to its design. JMP, WK, PP and TG were instrumental in creating datasets. SM prepared the initial draft of the manuscript and revised it based on co-authors’ feedback: J-ET, AH, JL, JMP, TG, JRG, LM, APC, WK and PP provided comments to the initial draft, further revisions and read and approved the final manuscript. The responsibility of study implementation lies with the principle investigator (SM) that is supported and supervised primarily by J-ET.

  • Funding This work is supported by personnel funding and in-kind analyst and epidemiologist support from the Ontario Drug Policy Research Network (ODPRN) and personnel awards from the Canadian Institutes of Health Research (CIHR) Drug Safety and Effectiveness Cross-Disciplinary Training (DSECT) Program, the Program For Assessment of Technology in Health (PATH) and an Ontario Graduate Scholarship (OGS). The ODPRN is funded by grants from the Ontario Ministry of Health and Long-Term Care (MOHLTC) and Ontario Strategy for Patient-Orientated Research (SPOR) Support Unit, which is supported by the Canadian Institutes of Health Research and the Province of Ontario. The opinions, results and conclusions reported in this article are those of the authors and are independent from the funding sources. No endorsement by the Ontario MOHLTC is intended or should be inferred.

  • Competing interests None declared.

  • Ethics approval This study has been approved by Hamilton Integrated Research Ethics Board (ID#1715-C).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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