The relationship between physician cost and functional status in the elderly

Objective. To explore the relationship between functional status and physic ian cost (general practitioner/specialist) in an elderly population. Design, setting and participants. A longitudinal study involving 328 patien ts aged 65 years or over admitted to medical and surgical wards of a Sydney metropolitan hospital over a 10-month period. Main outcome measures. Two predictive cost models were developed using mult iple linear regression analyses. Nine predictors were modelled including fu nctional status (Short Form 36; SF-36) and major diagnostic categories. The se models were then applied to the Australian SF-36 norms to produce a prof ile of cost by level of functioning. Results. After adjusting for potential confounders, five variables were fou nd to be predictive of general practitioner cost at a 5% significance level . Females and age were positively associated, whereas case note mention of post-discharge services and high SF-SG vitality and role emotional scores w ere negatively predictive. For specialist cost, five variables were statist ically significant. The SF-36 domains of physical functioning and mental he alth were positively associated. Higher vitality, role emotional scores and case note mention of post-discharge services were negatively associated. Conclusions. Cost models can be used to highlight the differences between g eneral practitioner and specialist attendances, guide future physician care of the aged, and facilitate informed decision making.