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. 2015 Dec;30(12):1741-7.
doi: 10.1007/s11606-015-3357-8.

Evaluating a Model to Predict Primary Care Physician-Defined Complexity in a Large Academic Primary Care Practice-Based Research Network

Clemens S Hong  1 , Steven J Atlas  2 , Jeffrey M Ashburner  2 , Yuchiao Chang  2 , Wei He  2 , Timothy G Ferris  2 , Richard W Grant  3
Affiliations

Evaluating a Model to Predict Primary Care Physician-Defined Complexity in a Large Academic Primary Care Practice-Based Research Network

Clemens S Hong et al. J Gen Intern Med. 2015 Dec.

Abstract

Background: Improving the ability to risk-stratify patients is critical for efficiently allocating resources within healthcare systems.

Objective: The purpose of this study was to evaluate a physician-defined complexity prediction model against outpatient Charlson score (OCS) and a commercial risk predictor (CRP).

Design: Using a cohort in which primary care physicians reviewed 4302 of their adult patients, we developed a predictive model for estimated physician-defined complexity (ePDC) and categorized our population using ePDC, OCS and CRP.

Participants: 143,372 primary care patients in a practice-based research network participated in the study.

Main measures: For all patients categorized as complex in 2007 by one or more risk-stratification method, we calculated the percentage of total person time from 2008-2011 for which eligible cancer screening was incomplete, HbA1c was ≥ 9 %, and LDL was ≥ 130 mg/dl (in patients with cardiovascular disease). We also calculated the number of emergency department (ED) visits and hospital admissions per person year (ppy).

Key results: There was modest agreement among individuals classified as complex using ePDC compared with OCS (36.7 %) and CRP (39.6 %). Over 4 follow-up years, eligible ePDC-complex patients had higher proportions (p < 0.001) of time with: incomplete cervical (17.8 % vs. 13.3 % for OCS; 19.4 % vs. 11.2 % for CRP), breast (21.4 % vs. 14.9 % for OCS; 22.7 % vs. 15.0 % for CRP), and colon (25.9 % vs. 18.7 % for OCS; 27.0 % vs. 18.2 % for CRP) cancer screening; HbA1c ≥ 9 % (15.6 % vs. 8.1 % for OCS; 15.9 % vs. 6.9 % for CRP); and LDL ≥ 130 mg/dl (12.4 % vs. 7.9 % for OCS; 11.8 % vs 9.0 % for CRP). ePDC-complex patients had higher rates (p < 0.003) of: ED visits (0.21 vs. 0.11 ppy for OCS; 0.17 vs. 0.15 ppy for CRP), and admissions in patients 45-64 and ≥ 65 years old (0.11 vs. 0.10 ppy AND 0.24 vs. 0.21 ppy for OCS).

Conclusion: Our measure for estimated physician-defined complexity compared favorably to commonly used risk-prediction approaches in identifying future suboptimal quality and utilization outcomes.

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Figures

Figure 1.
Figure 1.
a Complexity as defined by physician-defined complexity (ePDC) and outpatient Charlson Score (OCS).. b Complexity as defined by physician-defined complexity (ePDC) and a commercial risk predictor (CRP).
See this image and copyright information in PMC

Comment in

  • The Complexity of Complex Patients.
    Safford MM. Safford MM. J Gen Intern Med. 2015 Dec;30(12):1724-5. doi: 10.1007/s11606-015-3472-6. J Gen Intern Med. 2015. PMID: 26259761 Free PMC article. No abstract available.

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