The Impact of Patient Complexity on Healthcare Utilization
试验速览
- 阶段
- 不适用
- 发起方
- OCHIN, Inc.
- 入组人数
- 200,000
- 主要终点
- Provider Ranking as Assessed by Health Care Quality Metrics
研究概览
简要总结
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.
详细描述
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.
研究设计
- 研究类型
- Observational
- 观察模型
- Case Only
- 时间视角
- Retrospective
入排标准
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- 未提供
排除标准
- •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.
结局指标
主要结局
Provider Ranking as Assessed by Health Care Quality Metrics
时间窗: 1 year (2015)
Comparison of adjusted provider quality rankings with metrics adjusted for Charlson Morbidity Scores and Patient Panel Neighborhood Deprivation Indicators
次要结局
- Well Child Visits in first 15 Months of life (patient level)(15 months)
- Emergency Department Visits (Patient level)(1 year (2015))
- Colorectal Cancer Screening (Patient level)(1 year)
- Uncontrolled Hemoglobin A1c in Diabetics (patient level)(1 year)
- Avoidable Emergency Department Visits (Patient level)(1 year (2015))
- Screening for alcohol and drug misuse (patient level)(1 year (2015))