Clinical Outcome and Utilization Profiles Among Latent Groups of High-Risk Patients: Moving from Segmentation Towards Intervention.

Autor: Hutchins F; Center for Health Equity Research and Promotion, VA Pittsburgh Health Care System, University Drive (151C), Pittsburgh, PA, 15240, USA. Franya.Hutchins@va.gov.; Caring for Complex Chronic Conditions Research Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. Franya.Hutchins@va.gov., Thorpe J; Center for Health Equity Research and Promotion, VA Pittsburgh Health Care System, University Drive (151C), Pittsburgh, PA, 15240, USA.; Division of Pharmaceutical Outcomes & Policy, Eshelman School of Pharmacy, University of North Carolina - Chapel Hill, Chapel Hill, NC, USA., Maciejewski ML; Department of Population Health Sciences, Duke University Medical Center, Durham, NC, USA.; Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Medical Center, Durham, NC, USA., Zhao X; Center for Health Equity Research and Promotion, VA Pittsburgh Health Care System, University Drive (151C), Pittsburgh, PA, 15240, USA., Daniels K; Center for Health Equity Research and Promotion, VA Pittsburgh Health Care System, University Drive (151C), Pittsburgh, PA, 15240, USA.; Caring for Complex Chronic Conditions Research Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA., Zhang H; Center for Health Equity Research and Promotion, VA Pittsburgh Health Care System, University Drive (151C), Pittsburgh, PA, 15240, USA., Zulman DM; Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA.; Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA, USA., Fihn S; Division of General Internal Medicine, University of Washington School of Medicine, Seattle, WA, USA., Vijan S; VA Center for Clinical Management Research, Ann Arbor, MI, USA.; Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, MI, USA., Rosland AM; Center for Health Equity Research and Promotion, VA Pittsburgh Health Care System, University Drive (151C), Pittsburgh, PA, 15240, USA.; Caring for Complex Chronic Conditions Research Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Jazyk: angličtina
Zdroj: Journal of general internal medicine [J Gen Intern Med] 2022 Aug; Vol. 37 (10), pp. 2429-2437. Date of Electronic Publication: 2021 Nov 03.
DOI: 10.1007/s11606-021-07166-w
Abstrakt: Background: The ability of latent class models to identify clinically distinct groups among high-risk patients has been demonstrated, but it is unclear how healthcare data can inform group-specific intervention design.
Objective: Examine how utilization patterns across latent groups of high-risk patients provide actionable information to guide group-specific intervention design.
Design: Cohort study using data from 2012 to 2015.
Patients: Participants were 934,787 patients receiving primary care in the Veterans Health Administration, with predicted probability of 12-month hospitalization in the top 10 th percentile during 2014.
Main Measures: Patients were assigned to latent groups via mixture-item response theory models based on 28 chronic conditions. We modeled odds of all-cause mortality, hospitalizations, and 30-day re-hospitalizations by group membership. Detailed outpatient and inpatient utilization patterns were compared between groups.
Key Results: A total of 764,257 (81.8%) of patients were matched with a comorbidity group. Groups were characterized by substance use disorders (14.0% of patients assigned), cardiometabolic conditions (25.7%), mental health conditions (17.6%), pain/arthritis (19.1%), cancer (15.3%), and liver disease (8.3%). One-year mortality ranged from 2.7% in the Mental Health group to 14.9% in the Cancer group, compared to 8.5% overall. In adjusted models, group assignment predicted significantly different odds of each outcome. Groups differed in their utilization of multiple types of care. For example, patients in the Pain group had the highest utilization of in-person primary care, with a mean (SD) of 5.3 (5.0) visits in the year of follow-up, while the Substance Use Disorder group had the lowest, with 3.9 (4.1) visits. The Substance Use Disorder group also had the highest rates of using services for housing instability (25.1%), followed by the Liver group (10.1%).
Conclusions: Latent groups of high-risk patients had distinct hospitalization and utilization profiles, despite having comparable levels of predicted baseline risk. Utilization profiles pointed towards system-specific care needs that could inform tailored interventions.
(© 2021. This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply.)
Databáze: MEDLINE
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