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Building health plan databases to risk adjust outcomes and payments

Int J Qual Health Care 10:531-538. Center for Health Research, Kaiser Permanente, Northwest Division, Portland, OR, USA OBJECTIVES: To highlight the types and sources of […]

The changing shape of the physician workforce in prepaid group practice

Health Aff W4:60-63. Permanente Federation, Kaiser Permanente Health Care Program, Oakland, CA, USA Multiple factors have combined to change the size and specialty composition of […]

Does a large-scale organizational transformation toward patient-centered access change the utilization and costs of care for patients with diabetes?

Med Care Res Rev 69:519-539. Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA The authors examined whether Group Health’s […]

A hospital system’s wellness program linked to health plan enrollment cut hospitalizations but not overall costs

Health Aff 32:477-485. University of Arizona, Tucson, AZ, USA Many policy makers believe that health status would be improved and health care spending reduced if […]

Comparison of specialty referral rates in the United Kingdom and the United States: retrospective cohort analysis

BMJ 325:370-371. Health Services Research and Development Center, Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA […]

Effects of patient and physician practice socioeconomic status on the health care of privately insured managed care patients

Med Care 41:842-852. Department of Family and Community Medicine, Center for Health Services Research in Primary Care, University of California, Davis, USA BACKGROUND: Previous research […]

Diffusion into use of exenatide for glucose control in diabetes mellitus: a retrospective cohort study of a new therapy

Clin Ther 29:1784-1794. Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA BACKGROUND: Exenatide was approved by the US Food and Drug […]

Efficiency profile in the neurological referrals effectuate reference specialists: use case-mix system Adjusted Clinical Groups

An Med Interna 25:213-221. Published in Spanish. Badalona Serveis Assistencials S.A., Barcelona, Spain OBJECTIVES: To determine the general referral and neurological rate per center and […]

Is pharmacologic care of chronic obstructive pulmonary disease consistent with the guidelines?

Popul Health Manag 13:21-26. Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA Chronic obstructive pulmonary disease (COPD) […]

Mental health service use before and after diagnosis of early-onset bipolar disorder

J Behav Health Serv 38:398-413. Health Service and Population Research Department, Institute of Psychiatry, King’s College London, London, UK To investigate patterns of mental health […]

Potential Medicare savings through prevention and risk reduction

Popul Health Manag 14 Suppl 1:S35-S44. Healthways Center for Health Research, Franklin, TN, USA Medicare is challenged to maintain solvency as enrollment climbs because of […]

The relationship between financial incentives and quality of diabetes care in Ontario, Canada

Diabetes Care 35:1038-1046. Centre for Research on Inner City Health, Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, […]

Comparison of three methods for measuring multiple morbidity according to the use of health resources in primary healthcare

Aten Primaria 44:348-357. Published in Spanish. Badalona Serveis Assistencials, Badalona, Barcelona, Spain OBJECTIVE: To compare three methods of measuring multiple morbidity according to the use […]

Heart failure in primary care: co-morbidity and utilization of health care resources

Fam Pract 30:520-524. Bioengineering and Telemedicine Unit, Puerta de Hierro University Teaching Hospital, Majadahonda, Madrid, Spain BACKGROUND: In order to ensure proper management of primary […]

Risk-stratification methods for identifying patients for care coordination

Am J Manag Care 19:725-732. Mayo Clinic, Rochester, MN, USA BACKGROUND: Care coordination is a key component of the patient-centered medical home. However, the mechanism […]

Predictors of short-term postoperative survival after elective colectomy in colon cancer patients >/= 80 years of age

Ann Surg Oncol 20:1427-1435. Department of Surgery, UW Madison School of Medicine and Public Health, Madison, Wisconsin, USA BACKGROUND: Individuals ≥ 80 years of age […]

Movement disorders in elderly users of risperidone and first generation antipsychotic agents: a Canadian population-based study

PLoS One 8:e64217. Faculty of Pharmacy, University of Manitoba, Winnipeg, MB, Canada BACKGROUND: Despite concerns over the potential for severe adverse events, antipsychotic medications remain […]

Patient and Physician Factors Associated With Pulmonary Function Testing for COPD: A Population Study

Chest 145:272-281. Institute for Clinical Evaluative Sciences; Sunnybrook Research Institute; Sunnybrook Health Sciences Centre; University of Toronto, Toronto, ON, Canada BACKGROUND: The diagnosis of COPD […]

Identifying controlled substance patterns of utilization requiring evaluation using administrative claims data

Am J Manag Care 10:783-790. HSI Network LLC, USA OBJECTIVES: To develop a systems approach to identify, for further evaluation, patients with potential controlled substance […]

The meaningful use of electronic health records and health care quality

Am J Med Qual 30:512-519. Weill Cornell Medical College, New York, NY, USA The federal government is investing approximately $30 billion in incentives for adoption […]

Copayment level and drug switching: findings for type 2 diabetes

Am J Pharm Benefits 2:412-420. University of Hawaii at Manoa, Honolulu, HI, USA OBJECTIVE: To assess the relationship between copayment level and drug switching among […]

Does increased medication use among seniors increase risk of hospitalization and emergency department visits?

Working Paper 150004. Toronto, ON, Canada: Canadian Centre for Health Economics. Canadian Centre for Health Economics, Toronto, ON, Canada Objective: to examine the extent of […]

Diagnosis and disruption: understanding guideline-consistent dementia care and patterns of transition experienced by individuals with dementia

Vancouver, BC, Canada: University of British Columbia (doctoral dissertation). University of British Columbia, Vancouver, BC, Canada Introduction: Early detection and management, as outlined in dementia […]

CareOregon: transforming the role of a Medicaid health plan from payer to partner

New York, NY, USA: Commonwealth Fund. Commonwealth Fund, New York, NY, USA CareOregon, a Portland, Oregon-based nonprofit Medicaid health plan, developed two innovative programs to […]

The knowledge of morbidity in primary care as an aid in the planning and management of the services

Semergen doi:10.1016/j.semerg.2009.12.003. Published in Spanish. Servicio Canario de la Salud, Santa Cruzde Tenerife, Spain The analysis of the morbidity and management of its knowledge is […]

Allocating funds for healthcare in Manitoba regional health authorities: a first step – population-based funding

Winnipeg, MB, Canada: Manitoba Centre for Health Policy. Manitoba Centre for Health Policy, Dept. of Community Health Sciences, Faculty of Medicine, University of Manitoba, Winnipeg, […]

Managed care holds down costs, doesn’t hurt quality

Minneapolis Star Tribune, January 3:A13. No abstract

Risk adjustment lexicon

Reporting Framework Subcommittee of the Steering Committee of the Minnesota ACG Users Group. Revised by Chad Abrams, Terry Bernhardt, Steven Foldes, Jason Wiley, May 17, […]

Quality of care for Medicaid and privately insured children in a commercial insurance plan

Richmond, VA, USA: Virginia Commonwealth University (doctoral dissertation). Virginia Commonwealth University, Richmond, VA, USA The central thesis of this study is that exposure to the […]

Risk adjustment in competitive health plan markets

In: Culyer AJ, Newhouse JP, ed. Handbook of Health Economics, Volume 1. Amsterdam, Netherlands: Elsevier Science B. V.:755-845. Erasmus University, Rotterdam, Netherlands; Boston University, Boston, […]

Equity in health, health care services use and health care financing in British Columbia, 1992 and 2002

Vancouver, BC, Canada: University of British Columbia (doctoral dissertation). University of British Columbia, Vancouver, BC, Canada The objectives of this thesis are to identify equity […]

Work limitations and their relationship with morbidity burden in employed persons with diabetes

Baltimore, MD, USA: Johns Hopkins University (doctoral dissertation). Johns Hopkins University, Baltimore, MD, USA BACKGROUND. Work limitations are functional limitations within the work context resulting […]

The application of Johns Hopkins Adjusted Clinical Group Case-mix System in AFMS

In: Cato W, Roberts WC, ed. Proceedings of the 2011 AFMS Medical Research Symposium, Volume 4. Healthcare Informatics Track. August 2-4, 2011, National Harbor, MD, […]

Morbi-mortality and use of recourses after acute coronary syndrome in a Spanish population

Revista Clinica Espanola 211:560-571. Directorate of Planning, Badalona Serveis Assistencials SA, Badalona, Spain Morbi-mortality and use of recourses after acute coronary syndrome in a Spanish […]

A population-based study of healthcare resource utilization by metastatic gastric cancer patients in Ontario

Kingston, ON, Canada: Queens University (masters theseis). Queens University, Kingston, ON, Canada BACKGROUND: Gastric cancer is the fourth most common cancer in the world. Non-curative, […]

Association between use of a specialized diagnostic assessment unit and the diagnostic interval in Ontario breast cancer patients

Kingston, ON, Canada: Queen’s University (masters thesis). Queen’s University, Kingston, ON, Canada BACKGROUND: The amount of time that it takes to get a breast cancer […]

Comorbidity and healthcare expenditure in women with osteoporosis living in the Basque Country (Spain)

J Osteoporosis Basque Institute for Healthcare Innovation, Barakaldo, Spain BACKGROUND: The aim of the study was to estimate the prevalence of depression in the population […]

The Value of Patient Identification

Johns Hopkins Bloomberg School of Public Health The Value of Patient Identification Karen Kinder, PhD., MBA

One way of measuring morbidity of HA Patients

Hospital Authority One Way of Measuring Morbidity of HA Patients: from Research to Lessons Learnt Dr. Deacons Yeung Chief Manager

ACG 101

DST Health Solutions ACG 10 Lisa Kabasakalian

Applying the ACG System to support case management for the population of Eastern Cheshire

Integral Health Solutions Applying ACGs to care co-ordination, planning and commissioning Bernadette Bailey, Transformation Programme Manager, Eastern Cheshire CCG Jayne Molyneux, Care Co-ordination Advisor, Integral […]

Monday(C1)-Concurrent Resource Use and All Age Modeling – Abrams

Concurrent Resource Use and All Age Modeling – Chad Abrams

Monday(P5)-Understanding Transitions in Morbidity Burden: an Exploratory Analysis

David Linz, MA Robert Reid, MD, PhD  Paul Fishman, PhD 

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A Health Plan and the ACG System

At an event celebrating the ACG System receiving the 2015 Health Services Research (HSR) Award from AcademyHealth, Patricia M. C. Brown, Esq., President, Johns Hopkins […]

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Data Visualization and Patient Identification – Military

The Defense Health Agency (DHA) supports the delivery of integrated, affordable, and high-quality health services to Military Health System (MHS) beneficiaries and is responsible for […]

Genetics Consultation Rates Following a Diagnosis of High-Grade Serous Ovarian Carcinoma in the Canadian Province of Ontario

Objective: In 2001, the province of Ontario expanded cancer genetic testing eligibility to include all women with high-grade serous ovarian carcinoma (HGSC) of the ovary, […]

Is case-mix adjustment in primary care at the mercy of coding quality? Yes … and no

BACKGROUND:  Primary care clinicians know that case-mix varies between different physician practices and geographical areas. Leicester City Clinical Commissioning Group (CCG) is now able to quantify […]

Effectiveness of a community care management program for multimorbid elderly patients with heart failure in the Veneto Region

Abstract Background The rapidly growing population of elderly subjects with multimorbidity is at risk of receiving fragmented and uncoordinated care, and have frequent hospitalizations and […]

Population risk and burden of health behavioral–related all-cause, premature, and amenable deaths in Ontario, Canada: Canadian Community Health Survey–linked mortality files

Abstract   Purpose To examine the association of all-cause and premature mortality with four modifiable lifestyle behaviors and quantify the burden of behavioral-related premature death in Ontario, […]

An instrumental variable approach quantifies and confirms the duration of pre-transplant dialysis has negative impact on kidney transplant recipient survival

Abstract Dialysis prior to kidney transplantation may have a detrimental effect on post-transplant Outcomes. However, prior studies have not fully characterized the nature of this […]

Interaction between neighborhood walkability and traffic-related air pollution on hypertension and diabetes: The CANHEART cohort

Abstract Background Living in unwalkable neighborhoods has been associated with heightened risk for diabetes and hypertension. However, highly walkable environments may have higher concentrations of […]

Understanding those overdue for cancer screening by five years or more: A retrospective cohort study in Ontario, Canada

Abstract Populations that are more than just slightly overdue for breast, cervical and colorectal screening should likely be targeted for policy and practice interventions. We […]

Association of Patient, Prescriber, and Region With the Initiation of First Prescription of Biologic Disease-Modifying Antirheumatic Drug Among Older Patients With Rheumatoid Arthritis and Identical Health Insurance Coverage

Abstract Importance Prescribing the first biologic treatment for rheumatoid arthritis (RA) is an important decision for patients, their physicians, and payers, with considerable costs and […]

Multimorbidity patterns in patients with heart failure: an observational Spanish study based on electronic health records

Abstract Objectives To characterise the comorbidities of heart failure (HF) in men and women, to explore their clustering into multimorbidity patterns, and to measure the […]

A Revised Classification Algorithm for Assessing Emergency Department Visit Severity of Populations

ABSTRACT Objectives: Analyses of emergency department (ED) use require visit classification algorithms based on administrative data. Our objectives were to present an expanded and revised version […]

Health care service usage and costs for high-needs elderly patients with heart failure

Abstract Background Heart failure (HF) has been defined as global disease of pandemic proportions, since it affects around 26 million people worldwide.[1] According to a recent […]

Personalized prediction of early childhood asthma persistence: A machine learning approach

Abstract Objective Early childhood asthma diagnosis is common; however, many children diagnosed before age 5 experience symptom resolution and it remains difficult to identify individuals […]

Association Between Surgical Approach and Major Surgical Complications in Patients Undergoing Total Hip Arthroplasty

Abstract Objective To determine whether an anterior approach is associated with lower risk of complications than either a lateral or posterior approach. Design, Setting, and […]

Effect of frailty on postoperative readmissions and cost of care for ovarian cancer

Abstract Objectives Frailty, defined as loss of reserve and vulnerability to changes in health, affects many ovarian cancer patients who are planned to undergo surgery. […]

Healthcare resource utilization in myeloproliferative neoplasms: a population-based study from Ontario, Canada

Abstract Background Health resource utilization (HRU) and associated factors of high cost are not well understood in myeloproliferative neoplasms (MPNs). Methods In this population-based, retrospective […]

Impact of Coronary Artery Severity and Revascularization Prior to Transcatheter Aortic Valve Implantation

Abstract Objective The prevalence of coexisting coronary artery disease (CAD) is high in patients who underwent transcatheter aortic valve implantation (TAVI). Our objective was to […]

Stratifying for Value: An Updated Population Health Risk Stratification Approach

Abstract Objective Most risk stratification approaches attempt to predict clinical outcomes rather than value. For a provider organization or health system to have financial success […]

Kidney Function and Potassium Monitoring After Initiation of Renin-Angiotensin-Aldosterone System Blockade Therapy and Outcomes in 2 North American Populations

Abstract Background: Clinical practice guidelines recommend routine kidney function and serum potassium testing within 30 days of initiating ACE (angiotensin-converting enzyme) inhibitor or angiotensin II […]

Factors Associated With Nonreceipt of Recommended COPD Medications

Abstract Background COPD medications reduce exacerbations and improve quality of life. Despite this, some individuals do not receive medications recommended by practice guidelines. Research Question […]

Performance of quantitative measures of multimorbidity: a population-based retrospective analysis

Abstract Background Multimorbidity measures are useful for resource planning, patient selection and prioritization, and factor adjustment in clinical practice, research, and benchmarking. We aimed to […]

Identifying Complex Patients Using Adjusted Clinical Groups Risk Stratification Tool

ABSTRACT Objectives To produce an efficient and practically implementable method, based on primary care data exclusively, to identify patients with complex care needs who have […]

Validating and Improving Adjusted Clinical Group’s Future Hospitalization and High-Cost Prediction Models for Dutch Primary Care

Abstract The rise in health care costs, caused by older and more complex patient populations, requires Population Health Management approaches including risk stratification. With risk […]

Understanding Data and Opportunities Focused on Value: A Single-Center Experience in Headache Care

Abstract Background and Objectives Headache syndromes are highly prevalent, disabling, and costly. Our goals were to (1) describe headache care delivery and costs in a […]

Mapping Healthcare Needs: A Systematic Review of Population Stratification Tools

Abstract Background and Aim: In 2021, healthcare expenditure in Italy represented 7.3% of the national gross domestic product, with approximately 80% attributed to the management […]

Is the Barthel index a valid tool for patient selection before urological surgery? A systematic review

Background The Barthel Index (BI) measures the level of patient independence in activities of daily living. This review aims to summarize current evidence on the […]

Gaps in the Hepatitis C Prenatal and Postpartum Care Cascade: Rationale for Treatment in Pregnancy

Abstract Background Hepatitis C virus (HCV) infections have increased among younger populations, including pregnant people. While universal screening guidelines have improved case-finding, studies suggest low […]

Social Risk Factors and Their Effect on Health Care Costs in a Midwestern Health Care System

Abstract Objectives: To assess how social risk factors and socioeconomic status (SES) affect health care costs at a large, integrated health system of 45 clinics […]

Access to primary care is associated with improved long-term survival after severe traumatic injury

ABSTRACT BACKGROUND Survivors of severe traumatic injury remain at elevated risk of death in the years after injury. Little is known about how long-term mortality […]

A cross-sectional analysis of staffing, activity, and patient need in general practice in England in 2023: a retrospective cohort study

Abstract Background: General practice in England is experiencing rising demand, workforce diversification, and widening health inequalities. However, there is limited empirical evidence describing how general […]

A population-based study on the impact of social determinants of health on time to treatment of stage I lung cancer in Ontario, Canada

Abstract Background Timely treatment of Stage I non-small cell lung cancer (NSCLC) is essential to improving outcomes, yet disparities persist in access to treatment across […]

Improving Prediction of Risk of Admission to Long-Term Care or Mortality Among Home Care Users With IDD

ABSTRACT Background Frailty is an established predictor of admission into long-term care (LTC) and mortality in the elderly population. Assessment of frailty among adults with […]

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Case Finding and Population Profiling

This webinar focuses on a project undertaken in Slough Clinical Commissioning Group where information from the ACG System was used to profile the population of […]

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Leveraging Prescription Data to Derive Future Costs and Predictors Regarding Opioid Abuse Patients

Presented by: David Bodycombe, ScD, MSc

Director ACG System Research

This Webinar describes his study, which created and assessed three measures of high-risk opioid use, presents results supporting the utility of these measures, and describes how the resulting measures are being deployed within the ACG System. Learn More.

Risk prediction models to predict emergency hospital admission in community-dwelling adults: a systematic review

Med Care 52:751-756. Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin, Ireland BACKGROUND: Risk prediction models have been developed to identify […]

Frequent attenders in general practice and immigrant status in Norway: A nationwide cross-sectional study

Scand J Prim Health Care 32:232-240. Department of Global Public Health and Primary Care, University of Bergen, Norway OBJECTIVE: To compare the likelihood of being […]

Drugs prescribed by general practitioners according to age, gender and socioeconomic status after adjustment for multimorbidity level

BMC Fam Pract 15:183. Department of Clinical Sciences in Malmö, Center for Primary Health Care Research, Lund University, Malmö, Sweden BACKGROUND: Age, gender and socioeconomic […]

Direct medical costs attributable to venous thromboembolism among persons hospitalized for major operation: a population-based longitudinal study

Surgery 157:423-451. Mayo Clinic, Rochester, MN, USA; K Long Health Economics Consulting LLC, St. Paul, MN, USA BACKGROUND: We estimated medical costs attributable to venous […]

Preventive counseling services during primary care visits: a comparison of health centers versus other physician offices

J Health Care Poor Underserved 26:519-535. Johns Hopkins University, Baltimore, MD, USA We compared preventive counseling services provided by health centers versus other physician offices. […]

A comprehensive assessment of family physician gender and quality of care: a cross-sectional analysis in Ontario, Canada

Med Care 54:277-286. University of Ottawa, Ottawa, ON, Canada; Institute of Clinical Evaluative Sciences, Ottawa, ON, Canada; Queen’s University, Kingston, ON, Canada; Monash University, Clayton, […]

Prescription stimulant use and hospitalization for psychosis or mania: a population-based study

J Clin Psychopharmacol 35:667-671. Institute for Clinical Evaluative Sciences, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada; St Michael’s Hospital, Toronto, ON, Canada Small […]

Risk of cardiovascular events and mortality among a population-based cohort of immigrants and long-term residents with diabetes: Are all immigrants healthier and if so, for how long?

Am Heart J 170:123-132. University Health Network, Toronto, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada; Institute for Clinical Evaluative Sciences, Toronto, ON, Canada; University […]

Pain among older adults from a gender perspective: findings from the Swedish National Study on Aging and Care (SNAC-Blekinge)

Scand J Public Health Blekinge Institute of Technology, Karlskrona, Sweden; Lund University, Lund, Sweden; Linnaeus University, Växjö, Sweden BACKGROUND AND AIMS: Pain is common in […]

Ethnic disparities in care following acute coronary syndromes among Asian Americans and Pacific Islanders during the initial hospitalization

Cell Mol Biol 47:1209-1215. Hawaii Medical Service Association, Care Management, Honolulu, HI, USA Despite the fact that Asian Americans and Pacific Islanders are the fastest […]

Changes in health care costs over time following the cessation of intimate partner violence

J Gen Intern Med 25:920-925. Group Health Research Institute, Seattle, WA, USA BACKGROUND: Research has documented greater health care costs attributable to intimate partner violence […]

Universal health insurance and equity in primary care and specialist office visits: a population-based study

Ann Fam Med 7:396-405. Institute for Clinical Evaluative Sciences, Toronto, ON, Canada PURPOSE: Universal coverage of physician services should serve to reduce socioeconomic disparities in […]

Geographic variation in primary care visits in Iowa.

Health Serv Res 30:657-671. Graduate Program in Hospital and Health Administration, University of Iowa, Iowa City, IA, USA. OBJECTIVE: This study investigates the determinants of […]

Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data

Med Care 43:1130-1139. Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada OBJECTIVES: Implementation of the International Statistical Classification of Disease and Related […]

Epidemiology and impact of multimorbidity in primary care: a retrospective cohort study

Br J Gen Pract 61:e12-e21. Department of Community Medicine, University of Bristol, Bristol, UK BACKGROUND: In developed countries, primary health care increasingly involves the care […]

Predictive modeling in practice: improving the participant identification process for care management programs using condition-specific cut points

Popul Health Manag 14:205-210. Research and Development Unit, Johns Hopkins HealthCare LLC, Glen Burnie, MD, USA The objective of this study was to optimize predictive […]

Fracture risk from psychotropic medications: a population-based analysis

J Clin Psychopharmacol 28:384-391. Department of Psychiatry, University of Manitoba, Winnipeg, MB, Canada BACKGROUND: Selective serotonin reuptake inhibitors (SSRIs), benzodiazepines, and antipsychotics have each been […]