How to Classify Super-Utilizers: A Methodological Review of Super-Utilizer Criteria Applied to the Utah Medicaid Population, 2016-2017.

A limited number of patients, commonly termed super-utilizers, account for the bulk of health care expenditures. Multiple criteria for identifying super-utilizers exist, but no standard methodology is available for determining which criteria should be used for a specific population. Application is often arbitrary, and poorly aligned super-utilizer criteria might result in misallocation of resources and diminished effects of interventions. This study sought to apply an innovative, data-driven approach to classify super-utilizers among Utah Medicaid beneficiaries. The authors conducted a literature review of research methods to catalogue applied super-utilizer criteria. The most commonly used criteria were applied to Utah Medicaid beneficiaries enrolled during July 1, 2016-June 30, 2017, using their previous 12 months of claims data (N = 309,921). The k-medoids algorithm cluster analysis was used to find groups of beneficiaries with similar characteristic based on criteria from the literature. In all, 180 super-utilizer criteria were identified in the literature, 21 of which met the inclusion criteria. When these criteria were applied to Utah Medicaid data, 5 distinct subpopulation clusters were found: non-super-utilizers (n = 163,118), beneficiaries with multiple chronic or mental health conditions (n = 68,054), beneficiaries with a single chronic health condition (n = 43,939), emergency department super-utilizers with chronic or mental health conditions (n = 7809), and beneficiaries with uncomplicated hospitalizations (n = 27,001). This study demonstrates how cluster analysis can aid in selecting characteristics from the literature that systematically differentiate super-utilizer groups from other beneficiaries. This methodology might be useful to health care systems for identifying super-utilizers within their patient populations.

State-level adoption of national guidelines for norovirus outbreaks in health care settings.

BACKGROUND: Clinical decision support (CDS) systems can help investigators use best practices when responding to outbreaks, but variation in guidelines between jurisdictions can make such systems hard to develop and implement. This study aimed to identify (1) the extent to which state-level guidelines adhere to national recommendations for norovirus outbreak response in health care settings and (2) the impact of variation between states on outbreak outcomes. METHODS: State guidelines were obtained from Internet searches and direct contact with state public health officials in early 2016. Outcomes from norovirus outbreaks that occurred in 2015 were compared using data from the National Outbreak Reporting System. RESULTS: Guidelines were obtained from 41 of 45 (91%) state health departments that responded to queries or had guidelines available on their Web sites. Most state guidelines addressed each of the national recommendations, but specific guidance varied considerably. For example, among 36 states with guidance on numbers of stool specimens to collect, there were 21 different recommendations. Furthermore, having guidelines consistent with national recommendations was associated with fewer outbreaks reported and more outbreaks with confirmed etiology. CONCLUSIONS: This study identified substantial variation in state health care-associated norovirus outbreak response guidelines, which must be considered when developing related CDS systems. More research is needed to understand why this variation exists, how it impacts outbreak outcomes, and where improvements in evidence-based recommendations and communication of national guidance are needed.