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A systematic review of health care efficiency measures

Health Serv Res 44:784-805. RAND, Arlington, VA, USA OBJECTIVE: To review and characterize existing health care efficiency measures in order to facilitate a common understanding […]

Achieving cost control, care coordination, and quality improvement in the Medicaid program

J Ambul Care Manage 33:38-49; discussion 69-70. ACS Government Healthcare Solutions, Helena, MT, USA As Medicaid spending rises quickly, controlling cost while coordinating care and […]

Bone microarchitecture assessed by TBS predicts osteoporotic fractures independent of bone density: the Manitoba study

J Bone Miner Res 26:2762-2769. Bone Disease Unit, University of Lausanne, Lausanne, Switzerland The measurement of BMD by dual-energy X-ray absorptiometry (DXA) is the “gold […]

Two-year trends in colorectal cancer screening after switch to a high-deductible health plan

Med Care 49:865-871. Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA BACKGROUND: Recent health reform laws might […]

Postoperative health-care utilization in Crohn’s disease: the impact of specialist care

Am J Gastroenterol 107:1522-1529. Mount Sinai Hospital Centre for Inflammatory Bowel Disease, University of Toronto, Toronto, ON, Canad OBJECTIVES: Crohn’s disease (CD) patients frequently require […]

How does complementary private prescription drug insurance coverage affect seniors’ use of publicly funded medications?

Health Policy 110:147-155. School of Public Policy and Governance, University of Toronto, Toronto, ON, Canada BACKGROUND: Like in many other high-income jurisdictions, the public drug […]

Division of primary care services between physicians, physician assistants, and nurse practitioners for older patients with diabetes

Med Care Res Rev 70:531-541. University of Wisconsin–Madison, WI, USA; University of Pittsburgh School of Pharmacy, Pittsburgh, PA, USA Team-based care involving physician assistants and/or […]

Resources allocation and health care needs in diabetes care in Danish GP clinics

Health Policy 113:206-215. Institute of Public Health, Centre of Health Economics Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark BACKGROUND: In several […]

Measuring medical productivity to gauge the value of Medicare

Minn Med 96:46-48. Department of Finance, Medical Industry Leadership Institute, Carlson School of Management, University of Minnesota, Minneapolis, MN, USA. Having a measure of productivity […]

The effect of medical malpractice liability on rate of referrals received by specialist physicians

Health Econ Policy Law 8:453-475. Yale University School of Medicine, New Haven, CT, USA; Wayne State University, Detroit, MI, USA; University of Michigan, School of […]

Determinants of buprenorphine treatment for opioid dependence

J Subst Abuse Treat 46:315-319. Washington State University, Spokane, WA, USA; Group Health Research Institute, Seattle, WA, USA This study assessed the social, demographic and […]

How is the electronic health record being used? Use of EHR data to assess physician-level variability in technology use

J Am Med Inform Assoc Weill Cornell Medical College, New York, NY, USA BACKGROUND: Studies of the effects of electronic health records (EHRs) have had […]

Procedures take less time at ambulatory surgery centers, keeping costs down and ability to meet demand up

Health Aff 33:764-769. University of Louisville, Louisville, KY, USA; University of Minnesota, Minneapolis, MN, USA During the past thirty years outpatient surgery has become an […]

The association between parental depression and children’s health care utilization and expenditures: exploring the dimensions of parental gender and timing of depressive symptoms

Baltimore, MD, USA: Johns Hopkins University (doctoral dissertation). Department of Health Policy and Management, Johns Hopkins University, Baltimore, MD, USA Methods: The study used multiple […]

A descriptive analysis of the Ontario MedsCheck annual pharmacy medication review service

Canadian Pharmacists Journal 148:S27. OBJECTIVES: A MedsCheck Annual (MCA) consultation is a medication review service funded by the Ontario government for people taking three or […]

Associations among socioeconomic status (SES), patterns of care and outcomes in breast cancer (BC) patients (pts) in a universal health care system: Ontario’s experience

2014 American Society of Clinical Oncology Annual Meeting. Abstract 6625. J Clin Oncol 32 (suppl; abstr 6625). University of Toronto, Toronto, ON, Canada; Sunnybrook Health […]

The impact of not having a primary care physician among people with chronic conditions

Toronto, ON, Canada: Institute for Clinical Evaluative Sciences. Institute for Clinical Evaluative Sciences, Toronto, ON, Canada BACKGROUND: Primary care plays a pivotal role in health […]

Using the Adjusted Clinical Groups System to identify high-risk hemodialysis patients in Taiwan

J Healthc Manag 11:311-326. Published in Chinese. OBJECTIVES: There has been a rising number and cost of patients with regular hemodialysis in Taiwan. The objective […]

Risk distribution and risk assessment among enrollees in Washington state’s Medicaid SSI population

Hamilton, NJ, USA: Center for Health Care Strategies. Center for Health Care Strategies, Hamilton, NJ, USA Washington state began enrolling Medicaid SSI (low income, disabled) […]

Risk adjustment and rate setting methods in public programs

A report to legislature. St. Paul, MN, USA: Minnesota Department of Health. Health Economics Program, Minnesota Department of Health, St. Paul, MN, USA The 1995 […]

Updating and calibrating the Johns Hopkins University ACG/ADG risk adjustment method for application to Medicare risk contracting

Final report to Health Care Financing Administration. Baltimore, MD, USA: Johns Hopkins University. Johns Hopkins University, Baltimore, MD, USA The Balanced Budget Act (BBA) of […]

An operational framework for paying physician specialists a risk-adjusted fixed payment and incorporating the results in a global premium rating model

Los Angeles, CA, USA: UCLA (doctoral dissertation). University of California, Los Angeles, CA, USA The demand for more accurate and equitable professional medical specialty payments […]

Characteristics and utilization patterns of high-cost recipients in Medicaid population

MEDTAP 2001-2003 Research Project #1. Cincinnati, OH, USA: University of Cincinnati and Institute for Health Policy and Health Services Research. University of Cincinnati and Institute […]

Adjusting for patients’ clinical case mix explains variation in general practice prescribing

Research report no. 291, Department of Statistical Science. London, UK: University College London. University College London, London, UK BACKGROUND: The potential of using patient-level measures […]

Investigating whether the Johns Hopkins ACG case-mix system explains variation in UK general practice

London, UK: University College London (doctoral dissertation). University College London, London, UK This thesis describes the first large-scale studies in the United Kingdom to adjust […]

Familial aggregation of childhood health and the socioeconomic gradient of disease: a longitudinal population-based sibling analysis

Winnipeg, MB, Canada: University of Manitoba (masters thesis). University of Manitoba, Winnipeg, MB, Canada The Johns Hopkins ACG(r) Case-Mix System grouped various physician and hospital […]

Impact of rheumatoid arthritis on recognition of hypertension in a medically homed population

Arthritis Rheum 64:S712-S713. University of Wisconsin, Madison, WI, USA BACKGROUND/PURPOSE: Numerous studies report increased cardiovascular disease (CVD) events and others describe increased arterial stiffness in […]

Adjusted Clinical Groups (ACG) and co-morbidity

ImPrim Report D. Karlskrona, Sweden: ImPrim. Blekinge Centre of Competence, Karlskrona, Sweden No abstract

Depression, anxiety disorders, and related health care utilization in the Manitoba Metis population

Winnipeg, MB, Canada: Manitoba Metis Federation. Manitoba Metis Federation, Winnipeg, MB, Canada This report resulted from the need to understand further the findings in the […]

Leicester City CCG Case Study 3

Use of ACG® System output to support distribution of CCG Better Care Fund monies

Resource Allocation Case Study-Government

Sweden became one of the first international adopters of the Johns Hopkins ACG System in the mid 1990s and has expanded its use to cover […]

Poster: Morbidity Burden Resource Use and Quality of Care of Diabetic Patients

Morbidity burden, resource use and quality of care of diabetic patients: A 4-year cohort analysis at a regional hospital in Thailand. Roongkarn Pannarunothai, Buddhachinaraj Hospital, […]

Embedding ACGs in Berkshire

NHS Berkshire Embedding ACGs in Berkshire Karen Grannum Primary Care Business Intelligence Lead

Using the ACG Toolkit to Support Population Monitoring

DST Health Solutions Using the ACG Toolkit to Support Population Monitoring Lisa Kabasakalian

Monday(C3)-Identifying Potentially Actionable Chronic Disease Patterns From Diagnoses Reported in Administrative Claims-Dave Bodycombe

Identifying Potentially Actionable Chronic Disease Patterns From Diagnoses Reported in Administrative Claims —Dave Bodycombe, Johns Hopkins University

Tuesday(C6)-Integration of claim-based diagnoses with diagnoses from General Practitioners (GPs) clinical database records improves the comorbidity description”-Corti

 Integration of claim-based diagnoses with diagnoses from General  Practitioners (GPs) clinical database records improves the comorbidity description” Maria Chiara Corti,  E. Schievano F. Avossa, K. Kinder, […]

What causes ’poly-morbidity’? Searching for triggers of multi-morbidity: tracing patient record 30 years back

Lennart Carlsson, PhD; Gunnar H Nilsson, Professor; Centre for Family Medicine, Karolinska Institutet, Sweden

Beyond Risk Scores: Lisa Kabasakalian, DST Health Solutions

ACG System DST Health Solutions Beyond Risk Scores: Identifying “High-Risk” and “At-Risk” Populations Lisa Kabasakalian

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The ACG System Worldwide

ACG System Executive Director Karen Kinder, PhD, provides a candid tour of the ACG System’s international history and evolution to what is now the most […]

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Population Segmentation Case Study – Government

Three Clinical Commissioning Groups (CCGs) analyzed their local populations as part of a new national initiative to address the care of people who are frail.  Learn more.

Association of Suicidality and Depression With 5α-Reductase Inhibitors

IMPORTANCE There have been concerns raised by patients and regulatory agencies regarding serious psychiatric adverse effects associated with 5α-reductase inhibitors. OBJECTIVE To determine if there […]

Estimates and predictors of health care costs of esophageal adenocarcinoma: a population-based cohort study

Background Esophageal adenocarcinoma (EAC) incidence is increasing rapidly. Esophageal cancer has the second lowest 5-year survival rate of people diagnosed with cancer in Canada. Given […]

Equilibria in Health Exchanges: Adverse Selection versus Reclassification Risk

Abstract This paper studies regulated health insurance markets known as exchanges, motivated by the increasingly important role they play in both public and private insurance […]

Impact of stratification on the effectiveness of a comprehensive patient‐centered strategy for multimorbid patients

Abstract Objective The objective of this work was to assess the effectiveness of a population‐level patient‐centered intervention for multimorbid patients based on risk stratification for […]

Physician procedure volume and related adverse events after surgically induced abortion: a population-based cohort study

Abstract   BACKGROUND Induced abortion is a common procedure performed by physicians with varying degrees of clinical experience. We aimed to determine whether a physician’s […]

A comparison of population segmentation methods

Abstract This paper presents the first comparison of descriptive segmentation methods for population health management. The aim of descriptive segmentation is to identify heterogeneous segments […]

Determinants of vaccination uptake, and influenza vaccine effectiveness in preventing deaths and hospital admissions in the elderly population; Treviso, Italy, 2014/2015-2016/2017 seasons

ABSTRACT Seasonal influenza is an important cause of morbidity and mortality, particularly among the elderly population. Determinants of vaccination uptake and its impact on health […]

Colonoscopy resource availability and its association with the colorectal cancer diagnostic interval: A population-based cross-sectional study

Abstract BACKGROUND Colonoscopy is a key resource used to diagnose colorectal cancer (CRC). This study evaluated the relationship between colonoscopy availability and the length of […]

A systematic review of case-mix models for home health care payment: Making sense of variation

Abstract Background Case-mix based payment of health care services offers potential to contain expenditure growth and simultaneously support needs-based care provision. However, limited evidence exists […]

Assessing guideline-concordant care for patients with multimorbidity treated in a care management setting

Abstract   Background Disease-specific guidelines are not aligned with multimorbidity care complexity. Meeting all guideline-recommended care for multimorbid patients has been estimated but not demonstrated […]

Factors associated with waiting time to breast cancer diagnosis among symptomatic breast cancer patients: a population-based study from Ontario, Canada

Abstract Purpose A prolonged time from first presentation to cancer diagnosis has been associated with worse disease-related outcomes. This study evaluated potential determinants of a […]

Assessment of the Adjusted Clinical Groups system in Dutch primary care using electronic health records: a retrospective cross-sectional study

Abstract Background Within the Dutch health care system the focus is shifting from a disease oriented approach to a more population based approach. Since every […]

Association of perioperative red blood cell transfusions with all-cause and cancer-specific death in patients undergoing surgery for gastrointestinal cancer: Long-term outcomes from a population-based cohort

Abstract Background Red blood cell transfusions are common in patients undergoing gastrointestinal cancer surgery. Yet, to adequately balance their risks and benefits, clinicians must understand […]

Incidence of Access to Ambulatory Mental Health Care Prior to a Psychiatric Emergency Department Visit Among Adults in Ontario, 2010-2018

Abstract Importance Psychiatric emergency department (ED) visits may be avoidable if individuals have access to adequate outpatient care, but the extent to which individuals use […]

Healthcare utilization in patients with higher-risk MDS/low-blast count AML treated with azacitidine in the ‘real-world’

Abstract Background Despite the adoption of azacitidine (AZA) in higher-risk MDS/low-blast count AML, limited ‘real-world’ data on resource utilization and toxicity exist. Methods We linked […]

Association between Dysphagia and Surgical Outcomes across the Continuum of Frailty

Abstract Objective This study examined the relationship between dysphagia and adverse outcomes across frailty conditions among surgical patients ≥50 years of age. Methods A retrospective cohort […]

Allopurinol adherence, persistence and patterns of use in individuals with diabetes and gout: A retrospective, population-based cohort analysis

Abstract Objective There has been growing interest in the potential role for allopurinol to reduce cardiovascular events in people with diabetes. While adherence to allopurinol is poor […]

Multimorbidity Patterns in the General Population: Results from the EpiChron Cohort Study

Abstract Objective The correct management of patients with multimorbidity remains one of the main challenges for healthcare systems worldwide. In this study, we analyze the […]

Assessing the Value of Unsupervised Clustering in Predicting Persistent High Health Care Utilizers: Retrospective Analysis of Insurance Claims Data

Abstract Background A high proportion of health care services are persistently utilized by a small subpopulation of patients. To improve clinical outcomes while reducing costs […]

Impact of a high-risk multimorbidity integrated care implemented at the public health system in Chile

Abstract During recent years, multimorbidity has taken relevance because of the impact of causes in the system, people, and their families, which has been a […]

A bias evaluation checklist for predictive models and its pilot application for 30-day hospital readmission models

Abstract Objective Health care providers increasingly rely upon predictive algorithms when making important treatment decisions, however, evidence indicates that these tools can lead to inequitable […]

Latent Class Analysis of Social Needs in Medicaid Population and Its Impact on Risk Adjustment Models

Abstract Background: A growing number of US states are implementing programs to address the social needs (SNs) of their Medicaid populations through managed care contracts. […]

Differences in use of telemedicine integrated into traditional primary health care – a comparative observational study

Abstract Telemedicine in primary health care is expected to address many of the issues currently challenging service delivery. However, the impact and effect will depend […]

Prevalence and predictors of potentially inappropriate prescribing using codified STOPP-START and Beers criteria: a retrospective cohort study in Ontario’s older population

Abstract Objectives To quantify potentially inappropriate prescribing (PIP) and assess the association between patient characteristics and PIP using previously coded STOPP-START and Beers criteria in […]

Patterns of Telehealth Use Across the Cancer Care Continuum and Assessment of Patient and Geographic Factors Associated With Key Healthcare Outcomes: Retrospective Study

Abstract Background: Although the use of telehealth has declined since the pandemic, it remains a popular mode of care delivery across the cancer care continuum. […]

COVID-19 immunisation among individuals with opioid use disorder in Ontario: a population-based cohort study

Abstract Background The COVID-19 pandemic exacerbated health inequities, particularly among individuals with opioid use disorder (OUD). Disparities in vaccine uptake among people with OUD remain […]

Association between COVID-19 vaccination and sudden death in apparently healthy younger individuals: A population-based case-control study

Abstract Background COVID-19 vaccines can cause rare but serious adverse events such as myocarditis and immune thrombocytopenia. Despite a lack of strong evidence, concerns have […]

Opioid Use During Pregnancy among Individuals with Disabilities

ABSTRACT Introduction To investigate (1) prevalence and time trends in opioid use during pregnancy and (2) patterns of opioid use before and during pregnancy, among […]

Clinical and sociodemographic characteristics of limited and persistent uveitis cases: a population-based study

Abstract Objective To compare the clinical and sociodemographic characteristics of limited and persistent uveitis cases and temporal trends in incidence in Ontario. Methods A retrospective […]

Abstract Introduction: We aimed to compare the effectiveness of methadone and sublingual buprenorphine/naloxone and their association with treatment discontinuation using real-world data from Ontario, Canada. […]

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ACG System White Paper

 THE JOHNS HOPKINS ACG® SYSTEM is a leading risk measurement methodology that was developed and continues to be tested and improved at the Bloomberg School […]

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Risk Stratification: Identifying Geriatric Frailty from EHR Unstructured Data

With providers engaging more with risk stratification tools, unstructured data and free text from Electronic Health Records (EHRs), a potential exists to more effectively identify […]

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Care Density: A Social Network Approach to Claims Data

If optimizing quality of care, clinical outcomes and cost effectiveness is one of your priorities, ensuring your patient population receives comprehensive, coordinated care from their […]

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Understanding Population Health

With the challenges facing our health and social care services and the need to develop new care models to achieve the triple aim of improving […]

Risk aversion and costs: a comparison of family physicians and general internists

J Fam Pract 49:12-17. Department of Family Medicine, University of Rochester, New York, NY, USA No abstract Comment in: Interspeciality differences in medical resource utilization. […]

Obstructive sleep apnea and incident diabetes

A historical cohort study. Am J Respir Crit Care Med 190:218-225. University of Toronto, Toronto, ON, Canada; Institute for Clinical Evaluative Sciences, Toronto, ON, Canada; […]

The pattern of urologic care among traumatic spinal cord injured patients

Can Urol Assoc J 8:E805. Institute for Clinical Evaluative Sciences, Toronto, ON, Canada INTRODUCTION: We assessed the urologic care patterns of traumatic spinal cord injury […]

Risk factors for reoperation and mortality after the operative treatment of tibial plateau fractures in Ontario, 1996-2009

J Orthop Trauma 29:182-188. University of Toronto, Toronto, ON, Canada; Institute for Clinical Evaluative Sciences, Toronto, ON, Canada OBJECTIVE: To define the rates and risk […]

Do different case-mix measures affect assessments of provider efficiency? Lessons from the Department of Veterans Affairs

J Ambul Care Manage 26:229-242. Center for Health Quality, Outcomes and Economic Research, Bedford VAMC, Bedford, MA, USA Although case-mix adjustment is critical for provider […]

Achieving weight loss and hypertension control among obese adults: a US multidisciplinary group practice observational study

Am J Hypertens University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Veterans Affairs Pittsburgh Healthcare System , Pittsburgh, PA, USA; University […]

Association between the patient-centered medical home and healthcare utilization

Am J Manag Care 21:378-386. Weill Cornell Medical College, New York, NY, USA OBJECTIVES: The patient-centered medical home (PCMH) model of primary care is being […]

Caring for dementia: a population-based study examining variations in guideline-consistent medical care

Alzheimers Dement 11:906-916. UBC Centre for Health Services and Policy Research, School of Population and Public Health, Vancouver, BC, Canada BACKGROUND: Evidence indicates that early […]

What do we mean by multimorbidity? An analysis of the literature on multimorbidity measures, associated factors, and impact on health services organization

Rev Epidemiol Sante Publique 62:305-314. Hôpital Jean-Verdier, Bondy, France; Université Paris, Paris Cité, Bobigny, France BACKGROUND: Multimorbidity is a consequence of both epidemiological and demographic […]

The development of a risk-adjusted capitation payment system: the Maryland Medicaid model

J Ambul Care Manage 21:29-52. School of Public Health, Johns Hopkins University, Baltimore, MD, USA This article describes the risk-adjusted payment methodology employed by the […]

Does high-risk pool coverage meet the needs of people at risk for disability?

Inquiry 45:340-352. University of Kansas, Lawrence, KS, USA State high-risk insurance pools serve people denied coverage because of pre-existing conditions. With benefit plans modeled on […]

Comparison of Rx-defined morbidity groups and diagnosis-based risk adjusters for predicting healthcare costs in Taiwan

BMC Health Serv Res 10:126./p> Institute of Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan BACKGROUND: Medication claims are commonly used to […]

Classification systems in case-mix groups in ambulatory care. Perspectives for our primary health care

Aten Primaria 17:76-82. Published in Spanish. Unitat d’Investigació Centre, Institut Català de la Salut, CESCA, Barcelona, Spain No abstract PMID: 8742149

Proton-pump inhibitor use is not associated with osteoporosis or accelerated bone mineral density loss

Gastroenterology 138:896-904. Section of Gastroenterology, Division of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada BACKGROUNDS and AIMS: Recent studies have shown an association between […]

Primary care and specialty care for US children: what is the right mix?

Arch Pediatr Adolesc Med 157:219-220. Institute for Health Policy, MassGeneral Hospital for Children, Boston, MA, USA THE VERY TITLE of the article by Forrest et […]

Evaluation of the equity of age-sex adjusted primary care capitation payments in Ontario, Canada

Health Policy 104:186-192. Institute for Clinical Evaluative Sciences, Sunnybrook Health Sciences Centre, Toronto, ON, Canada OBJECTIVE: Several innovative primary care models have recently been introduced […]

Ambulatory care provided by office-based specialists in the United States

Ann Fam Med 7:104-111. National Primary Care Research and Development Centre, University of Manchester, Manchester, UK PURPOSE: Increasing use of specialist services in the United […]

Adjust utilization for case mix and make physicians responsible for remaining variation

Data Strateg Benchmarks 2:25-28. “But my patients are sicker!” Health Source/CIGNA put a stop to this physician complaint by switching to quarterly physician profiles that […]

Comparing the medical expenses of adults with Medicaid and commercial insurance in a health maintenance organization

J Health Care Poor Underserved 14:420-435. Division of Research, Kaiser Permanente Medical Care Program, Northern California Region, Oakland, CA, USA The objective of this study […]

Risk adjustment of mental health and substance abuse payments

Inquiry 35:223-239. Department of Health Care Policy, Harvard Medical School, Boston, MA, USA This study used 1992 and 1993 data from private employers to compare […]

The importance of the data quality in the validation of the ACG case mix

Ambulatory Care Groups. Aten Primaria 22:128. Published in Spanish. Osakidetza Servicio Vasco de Salud, Bizkaia, Spain No abstract Comment on:[A retrospective evaluation of the behaviour […]

Promoting advance directives among elderly primary care patients

J Gen Intern Med 19:944-951. Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA OBJECTIVE: To determine efficient ways of promoting advance directives among […]