Hospitalizations and emergency department use in Mayo Clinic Biobank participants within the employee and community health medical home

Abstract

Objective: To evaluate the participants in the Mayo Clinic Biobank for their representativeness to the entire Employee and Community Health program (ECH) primary care population with regard to hospital utilization.

Patients and methods: Participants enrolled in the Mayo Clinic Biobank from April 1, 2009, to December 31, 2010, were linked to the ECH population. These individuals were categorized into risk tiers (0-4) on the basis of the number of health conditions present as of December 31, 2010. Outcomes were ascertained through December 31, 2011. Hazard ratios (HRs) and 95% CIs for risk of hospitalization, emergency department (ED) visits, and for risk of hospitalization and emergency department (ED) visits were estimated.

Results: The 8927 Biobank participants were part of ECH (N=84,872). Compared with the entire ECH population, the Biobank-ECH participants were more likely to be female (64.3% vs 54.6%), older (median age, 58 years vs 47 years), and categorized to tier 0 (6.4% vs 24.0%). There were strong positive associations between tier (tier 4 vs combined tiers 0 and 1) and risk of hospitalization (HR, 5.8; 95% CI, 4.6-7.5) and ED visits (HR, 5.4; 95% CI, 4.2-6.8) among Biobank-ECH participants. Similar associations for risk of hospitalization (HR, 8.5; 95% CI, 7.8-9.3) and ED visits (HR, 6.9; 95% CI, 6.4-7.5) were observed for the entire ECH population.

Conclusion: Although the Biobank-ECH participants were older and had more chronic conditions compared with the overall ECH population, the associations of risk tier with utilization outcomes were similar, supporting the use of the Biobank participants to assess biomarkers for health care outcomes in the primary care setting.

Keywords: ACG; Adjusted Clinical Groups; ECH; ED; Employee and Community Health program; HR; emergency department; hazard ratio.

Figure 1

Age distribution of Biobank participants in ECH panel and overall ECH panel.

Figure 2

Percentages of Minnesota tiering scores (tier 0–4) at each age group (18 – 44, 45 – 54, 55 – 64, and 65 or older) for Biobank in ECH panel and the overall ECH.

Figure 3

Kaplan-Meier curves for comparing different tiering groups: (A) Hospitalization within 1-year; (B) ER visits within 1-year; and (C) 30-day re-hospitalization after the first hospitalization.