The Impact of Patient Complexity on Healthcare Utilization
- Conditions
- Well Child Visits in First 15 Months of Life NQF 1392Emergency Department UtilizationDiabetes Mellitus NQF 0059Alcohol and Drug ScreeningPrimary Care Quality MetricsColorectal Cancer Screening NQF 0034
- Interventions
- Other: Charlson score and Community Social Deprivation
- Registration Number
- NCT03327896
- Lead Sponsor
- OCHIN, Inc.
- Brief Summary
Healthcare providers are routinely being assessed for metrics designed to assess the quality of the care they deliver. There is growing consensus that these measurements, which typically assess the percentage of patients meeting a specific standard of care, should be adjusted for the clinical complexity of the providers. This study will assess whether adjusting for the social complexity of the patient panel adds significantly to adjustment for clinical complexity in explaining apparent differences in quality of care provided by Primary care providers and clinics.
- Detailed Description
The analysis will be conducted in 2 stages. In the first stage, indicators of social complexity (as assessed by characteristics of the patients' geocoded addresses) will be tested for significant association with patient level outcomes (meeting or not meeting a specific standard of care). These indicators will be assessed in 4 cohorts: 2 cohorts of patients identified in electronic health records of Clinical Research Networks of community health centers, and 2 cohorts of patients insured by Medicaid in 2015 (Oregon and Florida Medicaid cohorts). Due to limitations in the available data, some quality indicators can only be evaluated in a subset of the cohorts. The consistency of specific social complexity indicators, referred to as Community Vital Signs (CVS), will be evaluated across the cohorts and quality metrics.
In the second stage, CVS indicators that contributed consistently to models at the patient level will be evaluated for their effect on provider ranking on quality metrics if the metrics are adjusted for the social complexity of the providers' patient panel in addition to the panels' clinical complexity.
Recruitment & Eligibility
- Status
- UNKNOWN
- Sex
- All
- Target Recruitment
- 200000
Not provided
Exclusion criteria for patients: Patients with no geocoded address on file will be excluded from the analysis.
Exclusion criteria for patients for Medicaid based Outcomes: Patient with Medicaid coverage gaps of >45 days will be excluded from theses analyses. Exclusion criteria for providers: Providers with <20 patients in any Quality metric denominator.
Study & Design
- Study Type
- OBSERVATIONAL
- Study Design
- Not specified
- Arm && Interventions
Group Intervention Description OneFlorida EHR Charlson score and Community Social Deprivation Patients who were established patients at OneFlorida Primary Care clinics in 2015 and had a face to fact visit at the clinic in 2015. Inclusion criteria for specific outcomes varies by criteria for demoninator specification for the metric. Oregon Medicaid Charlson score and Community Social Deprivation Clients who were continuously insured through Oregon Medicaid in 2015 and had a claim with an Evaluation and Management Current Procedure Terminology (CPT) code indicating an office visit listing a Primary Care provider as the performing provider. Inclusion criteria for specific outcomes varies by criteria for demoninator specification for the metric. OCHIN EHR Charlson score and Community Social Deprivation Patients who were established patients at OCHIN Primary Care Clinics in 2015 and had a face to face visit at the clinic in 2015. Inclusion criteria for specific outcomes varies by criteria for demoninator specification for the metric. Florida Medicaid Charlson score and Community Social Deprivation Clients who were continuously insured through Florida Medicaid in 2015 and had a claim with an Evaluation and Management Current Procedure Terminology (CPT) code indicating an office visit listing a Primary Care provider as the performing provider. Florida Medicaid data is limited to clients who were 22 years or younger. Inclusion criteria for specific outcomes varies by criteria for demoninator specification for the metric.
- Primary Outcome Measures
Name Time Method Provider Ranking as Assessed by Health Care Quality Metrics 1 year (2015) Comparison of adjusted provider quality rankings with metrics adjusted for Charlson Morbidity Scores and Patient Panel Neighborhood Deprivation Indicators
- Secondary Outcome Measures
Name Time Method Well Child Visits in first 15 Months of life (patient level) 15 months Number of well child visits in first 15 months of life in children turning 15 months in 2015
Emergency Department Visits (Patient level) 1 year (2015) Age stratified Emergency department visit rates in patients in Medicaid cohorts
Colorectal Cancer Screening (Patient level) 1 year Documented colorectal cancer screening in 2015 (Oregon Medicaid cohort only)
Uncontrolled Hemoglobin A1c in Diabetics (patient level) 1 year Last recorded HbA1c greater than 9 in patients with recorded diagnosis of Diabetes (EHR cohorts only)
Avoidable Emergency Department Visits (Patient level) 1 year (2015) Age stratified Avoidable Emergency department visit rates in patients in Medicaid cohorts
Screening for alcohol and drug misuse (patient level) 1 year (2015) Documented screening for alcohol or drug misuse in patients aged 12 and over