Medication, diagnostic, and cost information as predictors of high-risk patients in need of care management

Published: January 1, 2009
Category: Bibliography > Papers
Authors: Bodycombe DP, Forrest CB, Lemke KW, Weiner JP
Countries: United States
Language: null
Types: Care Management
Settings: Hospital

Am J Manag Care 15:41-48.

Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

OBJECTIVE: To contrast the advantages and limitations of using medication, diagnostic, and cost data to prospectively identify candidates for care management programs.

METHODS: Risk scores from prior-cost information and a set of clinically based predictive models (PMs) derived from diagnostic and medication data sources, as well as from a combination of all 3 data sources, were assigned to a national sample of commercially insured, non-elderly adults (n = 2,259,584). Clinical relevance of risk groups and statistical performance using future costs as the outcome were contrasted across the PMs.

RESULTS: Compared with prior cost, diagnostic and medication-based PMs identified high-risk groups with a higher burden of clinically actionable characteristics. Statistical performance was similar and in some cases better for the clinical PMs compared with prior cost. The best classification accuracy was obtained with a comprehensive model that united diagnostic, medication, and prior-cost risk factors.

CONCLUSIONS: Clinically based PMs are a better choice than prior cost alone for programs that seek to identify high-risk groups of patients who are amenable to care management services.

PMID: 19146363

Medication,Cost Burden Evaluation,Predictive Risk Modeling,United States,Adolescent,Adult,Child,Preschool,Costs and Cost Analysis,Gender,Infant,Newborn,Insurance Claim Review,Middle Aged,Prospective Studies,Young Adult

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