Chaos to complexity: leveling the playing field for measuring value in primary care.
J Eval Clin Pract
; 23(2): 430-438, 2017 Apr.
Article
em En
| MEDLINE
| ID: mdl-25652744
ABSTRACT
RATIONALE, AIMS AND OBJECTIVES:
Develop a risk-stratification model that clusters primary care patients with similar co-morbidities and social determinants and ranks 'within-practice' clusters of complex patients based on likelihood of hospital and emergency department (ED) utilization.METHODS:
A retrospective cohort analysis was performed on 10 408 adults who received their primary care at the Medical University of South Carolina University Internal Medicine clinic. A two-part generalized linear regression model was used to fit a predictive model for ED and hospital utilization. Agglomerative hierarchical clustering was used to identify patient subgroups with similar co-morbidities.RESULTS:
Factors associated with increased risk of utilization included specific disease clusters {e.g. renal disease cluster [rate ratio, RR = 5.47; 95% confidence interval (CI; 4.54, 6.59) P < 0.0001]}, low clinic visit adherence [RR = 0.33; 95% CI (0.28, 0.39) P < 0.0001] and census measure of high poverty rate [RR = 1.20; 95% CI (1.11, 1.28) P < 0.0001]. In the cluster model, a stable group of four clusters remained regardless of the number of additional clusters forced into the model. Although the largest number of high-utilization patients (top 20%) was in the multiple chronic condition cluster (1110 out of 4728), the largest proportion of high-utilization patients was in the renal disease cluster (67%).CONCLUSIONS:
Risk stratification enhanced with disease clustering organizes a primary care population into groups of similarly complex patients so that care coordination efforts can be focused and value of care can be maximized.Palavras-chave
Texto completo:
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Temas:
ECOS
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Equidade_desigualdade
Bases de dados:
MEDLINE
Assunto principal:
Atenção Primária à Saúde
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Risco Ajustado
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Serviço Hospitalar de Emergência
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Hospitais
Tipo de estudo:
Etiology_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Aspecto:
Determinantes_sociais_saude
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Equity_inequality
Limite:
Adult
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Aged
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
J Eval Clin Pract
Assunto da revista:
PESQUISA EM SERVICOS DE SAUDE
Ano de publicação:
2017
Tipo de documento:
Article
País de afiliação:
Estados Unidos