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Population Health Management Exploiting Machine Learning Algorithms to Identify High-Risk Patients

Abstract Population aging and the increase of chronic conditions incidence and prevalence produce a higher risk of hospitalization or death. This is particularly high for […]

Neuropsychological and Behavioral Outcomes after Exposure of Young Children to Procedures Requiring General Anesthesia

Abstract   BACKGROUND Few studies of how exposure of children to anesthesia may affect neurodevelopment employ comprehensive neuropsychological assessments. This study tested the hypothesis that […]

Profiling hospital performance on the basis of readmission after transcatheter aortic valve replacement in Ontario, Canada

Abstract Background Readmission rates are a widely accepted quality indicator. Our objective was to develop models for calculating case‐mixed adjusted readmission rates after transcatheter aortic […]

Development and Validation of a Score to Predict Acute Care Use After Initiation of Systemic Therapy for Cancer

Abstract Importance  Emergency department visits and hospitalizations after starting systemic therapy for cancer are frequent, undesirable, and costly. A score to quantify the risk of […]

Incidence, Treatment, and Implications of Kidney Stones During Pregnancy: A Matched Population-Based Cohort Study

Abstract Purpose To determine the incidence of kidney stones in pregnancy, the risk of adverse birth outcomes, and treatment trends. Methods We performed a population-based […]

Factors associated with emergency department presentation after total joint arthroplasty: a population-based retrospective cohort study

Abstract Background Unplanned visits to the emergency department after total joint arthroplasty are far more common than unplanned readmissions. Our objectives were to characterize the […]

Uptake and survival effects of minimally invasive surgery for lung cancer: A population-based study

Abstract Introduction Despite growing evidence supporting the safety of minimally invasive surgery (MIS) in the treatment of lung cancer, its uptake is still variable and […]

Shifts in office and virtual primary care during the early COVID-19 pandemic in Ontario, Canada

ABSTRACT BACKGROUND Globally, primary care changed dramatically as a result of the coronavirus disease 2019 (COVID-19) pandemic. We aimed to understand the degree to which […]

A Propensity Score–weighted Comparison of Outcomes Between Living and Standard Criteria Deceased Donor Kidney Transplant Recipients

Abstract Background Consider a theoretical situation in which 2 patients with similar baseline characteristics receive a kidney transplant on the same day: 1 from a […]

Costs Associated with Nontuberculous Mycobacteria Infection, Ontario, Canada, 2001–2012

Abstract Objective To determine incidence-based healthcare costs attributable to nontuberculous mycobacterial (NTM) pulmonary disease (PD) and NTM pulmonary isolation (PI), from the healthcare payer perspective […]

Frailty as a predictor of outcomes in patients undergoing head and neck cancer surgery

Abstract Objectives To evaluate whether frailty and functional measures are predictors of perioperative complications and length of hospital stay (LOS) in patients undergoing head and […]

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 […]

Impact of High Deductible Health Plans on Diabetes Care Quality and Outcomes: Systematic Review

Abstract Objective High deductible health plans (HDHPs) were introduced as a mechanism to reduce healthcare spending by incentivizing patients to be more cost-conscious while making […]

Improving medication adherence and effective prescribing through a patient-centered prescription model in patients with multimorbidity

Abstract Purpose This study aimed to assess the impact of the patient-centered prescription (PCP) model in medication adherence and effective prescribing in patients with multimorbidity. […]

Indicators of publicly funded prescription opioid use among persons with traumatic spinal cord injury in Ontario, Canada

Abstract Objective To describe the proportion and identify predictors of community-dwelling individuals with traumatic spinal cord injury (TSCI) who were dispensed ≥1 publicly funded opioid […]

Analysis of Platelet Count and New Cancer Diagnosis Over a 10-Year Period

Abstract Importance Individuals with cancer often have an elevated platelet count at the time of diagnosis. The extent to which an elevated platelet count is […]

High-Deductible Health Plans Paired With Health Savings Accounts Increased Medication Cost Burden Among Individuals With Bipolar Disorder

ABSTRACT Objective High-deductible health plans paired with health savings accounts (HSA-HDHPs) require substantial out-of-pocket spending for most services, including medications. We examined effects of HSA-HDHPs […]

Social Determinants of Health Influence Future Health Care Costs in the Medicaid Cohort of the District of Columbia Study

Abstract Context Social determinants of health are an important predictor of future health care costs but little is known about their impact on Medicaid spending. […]

Effect of periodic health exam on provider management of preventive services

Abstract Rationale and objective To evaluate the relationship between receipt of annual physicals and the receipt of provider recommendation for preventive services, during a period […]

Using Additional Data Sets

This webinar explores the use of data sets from other Health and Social Care providers with the ACG system. In particular, it will focus on […]

Inter-Relationship Between Frailty & Multimorbidity

Presented by: Alan Thompson, MSc
Director of User Support, ACG System

Whilst it is true that resource use increases with an increasing degree of frailty, this presentation will demonstrate that not all frail patients are high cost and not all high cost patients are frail.

The excess medical cost and health problems of family members of persons diagnosed with alcohol or drug problems

Med Care 45:116-122. Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA BACKGROUND: Having a family member with substance use problems affects family functioning, […]

Is socioeconomic status associated with utilization of health care services in a single-payer universal health care system?

Int J Equity Health 13:115. Ben-Gurion University, Beer Sheva, Israel; Clalit Health Services, Tel Aviv, Israel OBJECTIVES: To assess an association of Socio-economic status with […]

Validation of 2 new measures of continuity of care based on year-to-year follow-up with known providers of health care

Ann Fam Med 12:559-567. Montreal Health and Social Services Agency, Montreal, QC, Canada PURPOSE: In a primary care context favoring group practices, we assessed the […]

The healthy migrant effect in primary care

Gac Sanit 29:15-20. Aragón Health Sciences Institute (IACS), Zaragoza, Spain; University of Zaragoza, Zaragoza, Spain; Miguel Servet University Hospital, Zaragoza, Spain; Carlos III Health Institute, […]

Medication oversupply in patients with diabetes

Res Social Adm Pharm 11:382-400. Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA; University of Pittsburgh, PA, USA; University of Wisconsin, Madison, WI, USA; Pharmacy […]

Prognostic factors in metastatic gastric cancer: results of a population-based, retrospective cohort study in Ontario

Gastric Cancer 19:150-159. Department of Surgery, Maimonides Medical Center, Brooklyn, NY, USA BACKGROUND: Stage IV gastric cancer is lethal, and little population-based research on prognostic […]

The temporal risk of heart failure associated with adjuvant trastuzumab in breast cancer patients: a population study

J Natl Cancer Inst 108:10. University of Toronto, Toronto, ON, Canada; St. Michael’s Hospital, Toronto, ON, Canada; Institute for Clinical Evaluative Sciences, Toronto, ON, Canada; […]

The origin of variation in primary care process and outcome indicators: patients, professionals, centers, and health districts

Medicine 94:e1314. Centro de Salud de Astrabudua (Primary Health Care Center of Astrabudua), Osakidetza (Basque Health Service), Erandio (Bizkaia), Spain; Primary Care Research Unit-Bizkaia, Osakidetza, […]

Characteristics of physicians and patients who join team-based primary care practices: evidence from Quebec’s Family Medicine Groups

Health Policy 116:264-272. McGill University, Montreal, QC, Canada; Direction de la santé publique de l’Agence de la Santé et des services sociaux de Montréal, Montreal, […]

Adjusted Clinical Groups Method (ACG) to allocate resources according to the disease burden of each health center

Santelices C E, Muñoz P F, Muñiz P, Rojas J. BACKGROUND: Health care must be provided with strong primary health care models, emphasizing prevention and a […]

Determining the morbidity profile, health-service utilization and health-provider efficiency in the Rejang River Basin, Sarawak, based on TPC® data and the Johns Hopkins ACG® System

BMC Health Serv Res 10:A8. Ministry of Health, Malaysia; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA Introduction: The study focused on the […]

Validating the Johns Hopkins ACG Case-Mix System of the elderly in Swedish primary health care

BMC Public Health 6:171. Blekinge Institute for Research & Development, Karlshamn, Sweden BACKGROUND: Individual based measures for comorbidity are of increasing importance for planning and […]

Use of diagnosis-based risk adjustment models to predict individual health care expenditure under the National Health Insurance system in Taiwan

J Formos Med Assoc 104:883-890. Graduate Institute of Health Care Organization Administration, College of Public Health, National Taiwan University, Taipei, Taiwan. BACKGROUND AND PURPOSE: Diagnostic […]

Risk adjustment using administrative data-based and survey-derived methods for explaining physician utilization

Med Care 48:175-182. Institute for Clinical Evaluative Sciences, Toronto, ON, Canada OBJECTIVES: The objective of this study was to evaluate an administrative data-based risk adjustment […]

An in-depth assessment of a diagnosis-based risk adjustment model based on national health insurance claims: the application of the Johns Hopkins Adjusted Clinical Group case-mix system in Taiwan

BMC Med 8:7. Department of Health Policy & Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA BACKGROUND: Diagnosis-based risk adjustment is […]

Predicting healthcare costs in a population of Veterans Affairs beneficiaries using diagnosis-based risk adjustment and self-reported health status

Med Care 42:1027-1035. Houston Center for Quality of Care and Utilization Studies, Health Services Research and Development Service, Michael E. DeBakey Veterans Affairs Medical Center, […]

Evaluation of guideline-concordant care for bipolar disorder among privately insured youth

Prim Care Companion J Clin Psychiatry 12:PCC.09m00837. Health Services Research Department, Institute of Psychiatry, King’s College London, London, UK OBJECTIVE: To describe and quantify the […]

Applying population-based case mix adjustment in managed care: the Johns Hopkins Ambulatory Care Group system

Manag Care Q 2:21-34. CSC Healthcare Systems, Inc., Malden, MA, USA When analyzing medical utilization or other health care-related measurements across provider panels, case mix […]

In search of the perfect comorbidity measure for use with administrative claims data: does it exist?

Med Care 44:745-753. Department of Family Medicine, University of Washington, Seattle, WA, USA BACKGROUND: Numerous measures of comorbidity have been developed for health services research […]

The development of Ambulatory Care Groups in primary care

Rev Neurol 29:667-669. Published in Spanish. Fundació Jordi Gol i Gurina, Barcelona, España INTRODUCTION: Ambulatory care groups (ACG) are a system of classification for patients […]

Comparison of private for-profit with private community-governed not-for-profit primary care services in New Zealand

J Health Serv Res Policy 9 Suppl 2:17-22. Department of Public Health, Wellington School of Medicine and Health Sciences, Wellington, New Zealand OBJECTIVE: To compare […]

Costs vs quality in different types of primary care settings

JAMA 272:1903-1908. Department of Health Policy and Management, School of Hygiene and Public Health, Johns Hopkins University, Baltimore, MD, USA OBJECTIVE: To determine the relationship […]

The validity of claims-based risk estimation in underinsured populations

Am J Manag Care 18:e468-e476. Institute for Health and Disability Policy Studies, University of Kansas, Lawrence, KS OBJECTIVES: To demonstrate a threat to validity in […]

The post-fracture care gap among Canadian First Nations peoples: a retrospective cohort study

Osteoporos Int 23:929-936. Department of Medicine, University of Manitoba, 409 Tache Avenue, Winnipeg, MB, Canada Despite targeted attempts to reduce post-fracture care gaps, we hypothesized […]

Taking health status into account when setting capitation rates: a comparison of risk-adjustment methods

JAMA 276:1316-1321. Health Research Center, Institute for Research and Education, HealthSystem Minnesota, Minneapolis, MN, USA OBJECTIVE: To compare performance of different health status measures for […]

Cardiology workforce: a shortage, not a surplus

Health Aff W4:64-66. Mayo Clinic College of Medicine, Rochester, MN, USA The United States faces a serious shortage of cardiologists as our population ages and […]

Adjusted Clinical Groups use as a measure of the referrals efficiency from primary care to specialized in Spain

Eur J Public Health 17:657-663. Planning Management, Badalona Serveis Assistencials, SA, Badalona, Barcelona, Spain BACKGROUND: To determine the referral rate (RR) per centre, its main […]

Medicaid managed care payment rates in 1998

Health Aff 18:217-227. Urban Institute, Washington, DC, USA This paper reports on a new survey of state Medicaid managed care payment rates. We collected rate […]

Chronic care improvement in primary care: evaluation of an integrated pay-for-performance and practice-based care coordination program among elderly patients with diabetes

Health Serv Res 45:1763-1782. Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Johns Hopkins Healthcare LLC, Glen Burnie, MD, USA OBJECTIVE: […]

Implementation of electronic medical records: effect on the provision of preventive services in a pay-for-performance environment

Can Fam Physician 57:e381-e389. Department of Family and Community Medicine, University of Toronto, ON, Canada OBJECTIVE: To study the effect of electronic medical record (EMR) […]

Estimation of chronic co-morbidity on health costs in elderly patients with neurological disorders

Rev Peru Med Exp Salud Publica 28:564-565. Published in Spanish. Directorate of Planning, Badalona Serveis Assistencials SA, Badalona, Spain Sr. Editor. El envejecimiento progresivo de […]

Medical care costs associated with traumatic brain injury over the full spectrum of disease: a controlled population-based study

J Neurotrauma 29:2038-2049. Mayo Clinic, Rochester, MN, USA Data on traumatic brain injury (TBI) economic outcomes are limited. We used Rochester Epidemiology Project (REP) resources […]

The performance of administrative and self-reported measures for risk adjustment of Veterans Affairs expenditures

Health Serv Res 40:887-904. Health Services Research and Development Northwest Center of Excellence, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA. OBJECTIVE: To […]

Socio-economic position and childhood multimorbidity: a study using linkage between the Avon Longitudinal study of parents and children and the general practice research database

Int J Equity Health 12:66. School of Social and Community Medicine, University of Bristol, Bristol, UK INTRODUCTION: In adults, multimorbidity is associated with social position. […]

Use of risk adjustment in setting budgets and measuring performance in primary care II: advantages, disadvantages, and practicalities

BMJ 323:607-610. School of Public Policy, University College London, London, UK Risk adjustment could help to improve decisions about budgets as well as help measure […]

Prevalence of multimorbidity according to the deprivation level among the elderly in the Basque Country

BMC Public Health 13:918. Oberri, Basque Institute for Healthcare Innovation, Sondika, Spain BACKGROUND: Multimorbidity is clearly a major challenge for healthcare systems. However, currently, its […]

Predictors of colorectal cancer screening variation among primary-care providers and clinics

Am J Gastroenterol 108:1159-1167. University of Wisconsin School of Medicine and Public Health, Madison, WI, USA OBJECTIVES: Colorectal cancer (CRC) screening is underutilized. To effect […]

Antihypertensive medication initiation among young adults with regular primary care use

J Gen Intern Med Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA BACKGROUND: Young adults with hypertension have […]

Systemwide provider performance in a Medicaid program. Profiling the care of patients with chronic illnesses

Med Care 34:798-810. Department of Health Policy and Management, Johns Hopkins University School of Public Health, Baltimore, MD, USA OBJECTIVES: This study illustrates how claims […]

Obesity and co-morbidities in type 2 diabetes: an opportunity to bend the Health Care Cost Curve

Rev Clin Esp 214:140-142. University of Southern Denmark, Odense, Denmark Obesity has long been known as a driver and predictor of the increasing global prevalence […]

Using a health information exchange system for imaging information: patterns and predictors

AMIA Annu Symp Proc 2013:1402-1411. Weill Cornell Medical College, New York, NY, USA Health information exchange (HIE) systems may address the challenges that prevent easy […]

Children and youth with traumatic brain injury: Who uses homecare services, what do they use, and how much does it cost?

First International Conference on Pediatric Acquired Brain Injury, September 2015, Liverpool, UK. University of Toronto, Toronto, ON, Canada Objective: To determine, by sex, the predictors, […]

Women are less likely to be admitted for inpatient rehabilitation after hypoxic-ischemic brain injury

Arch Phys Med Rehabil 96:e17-e18. Toronto Rehabilitation Institute, Toronto, ON, Canada Objective(s): To investigate demographic and acute care clinical determinants  of admission to inpatient rehabilitation […]

Child health and young adult outcomes

J Hum Resources 45:517-548. Columbia University, New York, NY, USA; University of Toronto, Toronto, ON, Canada; University of Manitoba, Winnipeg, MB, Canada Research has shown […]

Patients gain information and skills to improve self-management through innovative tools

Quality Matters December 2010/January 2011. Commonwealth Fund, New York, NY, USA Health reform strategies such as creating patient-centered medical homes depend on an actively engaged […]

What works? A first look at evaluating Manitoba’s regional health programs and policies at the population level

Winnipeg, MB, Canada: Manitoba Centre for Health Policy. Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB, Canada Although many descriptive healthcare studies are […]

The New Mexico primary care network

Chapter 5. In: Gavin NI, Farrelly MC, ed. Evaluation of Medicaid managed care programs with 1915(b) waivers. Presented to HCFA Office of R&D. Rockville, MD, […]

Johns Hopkins risk tool used in south

EHI ehealth Insider :5 March 2012. More than 200 GP practices in South Central England are getting quarterly risk stratification and predictive modelling information on […]

Health system use by frail Ontario seniors: an in-depth examination of four vulnerable cohorts

Toronto, ON, Canada: Institute for Clinical Evaluative Sciences. Institute for Clinical Evaluative Sciences, Toronto, ON, Canada Key Findings OLDER WOMEN: A look at gender differences […]

Predicting elderly at risk of increased future healthcare use: how much does diagnostic information add to prior utilization?

Health Serv Outcomes Res Methodology 3:266-277. Adamian Academic Center, Bentley College, Waltham, MA, USA; Center for Health Quality, Outcomes and Economic Research, Veterans Administration Medical […]

Hopkins health pricing tool a managed care hit

Hopkins health pricing tool a managed care hit. Baltimore Business Journal July 21. Baltimore Business Journal, Baltimore, MD, USA Johns Hopkins University’s links with private […]

Event analysis of all-cause and ambulatory care sensitive hospitalization of long-stay nursing home residents

Baltimore, MD, USA: Centers for Medicare and Medicaid Services. Schneider Institutes for Health Policy, The Heller School for Social Policy and Management, Brandeis University, Waltham, […]

Adult obesity in Manitoba: prevalence, associations, and outcomes, 3rd edition

Winnipeg, MB, Canada: Manitoba Centre for Health Policy. Manitoba Centre for Health Policy, Winnipeg, MB, Canada Obesity is a major public health concern in Canada […]

Healthcare expenditure in the last year of life: the experience of South African medical schemes

Cape Town, South Africa: Actuarial Society of South Africa. School of Management Studies, University of Cape Town, Rondebosch, South Africa The aim of this paper […]

Pressupostos e proposta de modelo para a remuneração do trabalho do médico cirurgião nas operadoras de planos de saúde

São Paulo, Brazil: Fundação Getúlio Vargas, Escola de Administração de Empresas de São Paulo (doctoral dissertation). Published in Portuguese. Fundação Getúlio Vargas, Escola de Administração […]

A predictive model to identify patients at risk of unplanned 30-day acute care hospital readmission

In: 2013 IEEE International Conference on Healthcare Informatics, September 9-11, 2013, Philadelphia, PA, USA. Los Alamitos, CA, USA: IEEE:551-556. Department of Health Policy and Management, […]

Central Midlands CSU Case Study

Midlands and Lancashire CSU – ACG® System Case Management Report

Population Health and Resource Allocation Case Study Payer

Slough CCG used data output from the Johns Hopkins ACG System to gain a better understanding of their patient population, understand the factors that drive […]

Population Health Management: A Focus On Analytics Using ACGs

Johns Hopkins HealthCare LLC   Population Health Management: A Focus On Analytics Using ACGs Martha Sylvia, PhD, MBA, RN

Monday(C2)-The Association between Patient Sharing among Physicians and Cost of Care-Lemke

The Association between Patient Sharing among Physicians and Cost of Care-Klaus Lemke

Tuesday(C6)-Do Real Time Clinical Measures Improve the Performance of ACG Based Predictive Models?-Fishman

Do Real Time Clinical Measures Improve the Performance of ACG Based Predictive Models? Paul Fishman, PhD  Robert Reid, MD, PhD 

AcademyHealth 2015 HSR Impact Awardee Summary description of the ACG System

2015 HSR Impact Awardee The Johns Hopkins ACG Case-Mix System

The ACG System and Care Management

Linda Dunbar, Vice President of Population Health Care Management at Johns Hopkins HealthCare discusses how the ACG System assisted with Care Management for high-risk individuals […]

Resource Allocation Case Study-Government

The Ministry of Health in Chile used the ACG® System as a risk-adjustment mechanism to improve health care resource allocation and better describe the disease […]

The uptake of active surveillance for the management of prostate cancer: A population-based analysis

Introduction: Active surveillance (AS) is a strategy for the management of low-risk prostate cancer (PCa). However, few studies have assessed the uptake of AS at […]

Apples and Oranges: Four Definitions of Multiple Chronic Conditions and their Relationship to 30-Day Hospital Readmission

Health Innovation Program, the University of Wisconsin School of Medicine and Public Health from The Wisconsin Partnership Program, and the Community–Academic Partnerships core of the […]

Primary care utilization in people who experience imprisonment in Ontario, Canada: a retrospective cohort study

Abstract Background Access to primary care is an important determinant of health, and data are sparse on primary care utilization for people who experience imprisonment. […]

Vulnerable And Less Vulnerable Women In High-Deductible Health Plans Experienced Delayed Breast Cancer Care

ABSTRACT The effects of high-deductible health plans (HDHPs) on breast cancer diagnosis and treatment among vulnerable populations are unknown. We examined time to first breast […]

Patient-reported symptoms after breast cancer diagnosis and treatment: A retrospective cohort study

Abstract Aim Breast cancer and its treatment are associated with varying symptoms. The province of Ontario (13.6 million) has implemented a provincial programme to screen for symptoms among […]

Performance on the Operant Test Battery in young children exposed to procedures requiring general anaesthesia: the MASK study

Abstract Background It is not known whether the neurotoxicity produced by anaesthetics administered to young animals can also occur in children. Exposure of infant macaques […]

Prevalence of intellectual and developmental disabilities among first generation adult newcomers, and the health and health service use of this group: A retrospective cohort study

Abstract Background Attention to research and planning are increasingly being devoted to newcomer health, but the needs of newcomers with disabilities remain largely unknown. This […]

Multimorbidity Patterns in Patients with Back Pain: A Study of Patient Records at a Primary Health Care Centre in Sweden

Abstract In Primary Care, multimorbidity is the norm in most patients. A large part of these have pain disorders, very often related to the spine. […]

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