Defining and Assessing Geriatric Risk Factors and Associated Health Care Utilization Among Older Adults Using Claims and Electronic Health Records
| Autor: | Joe Kimura, Bruce Leff, Elyse C. Lasser, Jonathan P. Weiner, Shannon Wu, Laura Anzaldi, Ashwini Davison, Hongjun Kan, Hsien Yen Chang, Cynthia M. Boyd, Thomas M. Richards, Hadi Kharrazi |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Male
medicine.medical_specialty Adverse outcomes Population health Health records Logistic regression 03 medical and health sciences 0302 clinical medicine Risk Factors Health care Electronic Health Records Humans Medicine 030212 general & internal medicine Aged Retrospective Studies Service (business) business.industry 030503 health policy & services Public Health Environmental and Occupational Health Geriatric assessment Patient Acceptance of Health Care United States Geriatrics Family medicine Female 0305 other medical science business Population Health Management Administrative Claims Healthcare |
| Zdroj: | Medical Care. 56:233-239 |
| ISSN: | 0025-7079 |
| Popis: | Using electronic health records (EHRs), in addition to claims, to systematically identify patients with factors associated with adverse outcomes (geriatric risk) among older adults can prove beneficial for population health management and clinical service delivery.To define and compare geriatric risk factors derivable from claims, structured EHRs, and unstructured EHRs, and estimate the relationship between geriatric risk factors and health care utilization.We performed a retrospective cohort study of patients enrolled in a Medicare Advantage plan from 2011 to 2013 using both administrative claims and EHRs. We defined 10 individual geriatric risk factors and a summary geriatric risk index based on diagnosed conditions and pattern matching techniques applied to EHR free text. The prevalence of geriatric risk factors was estimated using claims, structured EHRs, and structured and unstructured EHRs combined. The association of geriatric risk index with any occurrence of hospitalizations, emergency department visits, and nursing home visits were estimated using logistic regression adjusted for demographic and comorbidity covariates.The prevalence of geriatric risk factors increased after adding unstructured EHR data to structured EHRs, compared with those derived from structured EHRs alone and claims alone. On the basis of claims, structured EHRs, and structured and unstructured EHRs combined, 12.9%, 15.0%, and 24.6% of the patients had 1 geriatric risk factor, respectively; 3.9%, 4.2%, and 15.8% had ≥2 geriatric risk factors, respectively. Statistically significant association between geriatric risk index and health care utilization was found independent of demographic and comorbidity covariates. For example, based on claims, estimated odds ratios for having 1 and ≥2 geriatric risk factors in year 1 were 1.49 (P0.001) and 2.62 (P0.001) in predicting any occurrence of hospitalizations in year 1, and 1.32 (P0.001) and 1.34 (P=0.003) in predicting any occurrence of hospitalizations in year 2.The results demonstrate the feasibility and potential of using EHRs and claims for collecting new types of geriatric risk information that could augment the more commonly collected disease information to identify and move upstream the management of high-risk cases among older patients. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|