{"doi":"10.1371/journal.pone.0262079","title":"Healthcare utilization and costs among high-need and frail Mexican American Medicare beneficiaries","abstract":"OBJECTIVES: To examine Medicare health care spending and health services utilization among high-need population segments in older Mexican Americans, and to examine the association of frailty on health care spending and utilization. METHODS: Retrospective cohort study of the innovative linkage of Medicare data with the Hispanic Established Populations for the Epidemiologic Study of the Elderly (H-EPESE) were used. There were 863 participants, which contributed 1,629 person years of information. Frailty, cognition, and social risk factors were identified from the H-EPESE, and chronic conditions were identified from the Medicare file. The Cost and Use file was used to calculate four categories of Medicare spending on: hospital services, physician services, post-acute care services, and other services. Generalized estimating equations (GEE) with a log link gamma distribution and first order autoregressive, correlation matrix was used to estimate cost ratios (CR) of population segments, and GEE with a logit link binomial distribution was applied to estimate odds ratios (OR) of healthcare use. RESULTS: Participants in the major complex chronic illness segment who were also pre-frail or frail had higher total costs and utilization compared to the healthy segment. The CR for total Medicare spending was 3.05 (95% CI, 2.48-3.75). Similarly, this group had higher odds of being classified in the high-cost category 5.86 (95% CI, 3.35-10.25), nursing home care utilization 11.32 (95% CI, 3.88-33.02), hospitalizations 4.12 (95% CI, 2.88-5.90) and emergency room admissions 4.24 (95% CI, 3.04-5.91). DISCUSSION: Our findings highlight that frailty assessment is an important consideration when identifying high-need and high-cost patients.","journal":"PLoS ONE","year":2022,"id":266985,"datarank":0.46659148743382134,"base_score":2.1972245773362196,"endowment":2.1972245773362196,"self_citation_contribution":0.32958368660043297,"citation_network_contribution":0.13700780083338837,"self_endowment_contribution":0.32958368660043297,"citer_contribution":0.13700780083338837,"corpus_percentile":59.33317861839561,"corpus_rank":5258,"citation_count":8,"citer_count":8,"citers_with_citation_signal":6,"citers_with_endowment":6,"datacite_reuse_total":0,"is_dataset":true,"is_dataset_confidence":0.8429,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2022-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":447787,"name":"Amit Kumar","orcid":"0000-0002-0125-6759","position":1,"is_corresponding":false},{"id":339829,"name":"Lin‐Na Chou","orcid":"0000-0003-0779-714X","position":2,"is_corresponding":false},{"id":785835,"name":"Tamra Keeney","orcid":"0000-0002-2603-8707","position":3,"is_corresponding":false},{"id":520717,"name":"Nasim Ferdows","orcid":"0000-0003-4380-1556","position":4,"is_corresponding":false},{"id":383843,"name":"Amol Karmarkar","orcid":"0000-0001-8355-1585","position":5,"is_corresponding":false},{"id":340932,"name":"Kyriakos S. Markides","orcid":null,"position":6,"is_corresponding":false},{"id":339831,"name":"Kenneth J. Ottenbacher","orcid":"0000-0001-5990-3982","position":7,"is_corresponding":false},{"id":447785,"name":"Maricruz Rivera‐Hernandez","orcid":"0000-0001-5623-9609","position":0,"is_corresponding":true}],"reference_count":36,"raw_metadata":null,"created_at":"2026-07-19T00:27:02.050512Z","pmid":"35030180","pmcid":"PMC8759642","fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}