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Johns Hopkins Ambulatory Care Groups (ACGs). A case-mix system for UR, QA and capitation adjustment

HMO Pract 6:13-19. Johns Hopkins University, Baltimore, MD, USA This paper describes a new ambulatory case-mix system developed at The Johns Hopkins University and known […]

Impact of comorbidities on stroke rehabilitation outcomes: does the method matter?

Arch Phys Med Rehabil 89:1903-1906. Center for Health Quality, Outcomes and Economic Research, Bedford VA Hospital, Bedford, MA, USA OBJECTIVES: To examine the impact of […]

Pay for performance: an excellent idea that simply needs implementation

Qual Manag Health Care 14:31-44. 3M Health Information Systems, Wallingford, CT, USA Pay for performance cannot consist of a one-size-fits-all approach. Variation in quality and […]

Comparative study at 4 health centres of efficiency, measured on the basis of Ambulatory Care Groups

Aten Primaria 38:275-282. Published in Spanish. Badalona Serveis Assistencials, Badalona (Barcelona), España OBJECTIVE: To measure efficiency in the use of resources for the care lists […]

Do Adjusted Clinical Groups eliminate incentives for HMOs to avoid substance abusers? Evidence from the Maryland Medicaid HealthChoice program

J Behav Health Serv Res 30:63-77. UCLA Department of Medicine, Division of General Internal Medicine & Health Services Research, Los Angeles, CA, USA The adequacy […]

Cholecystostomy: a bridge to hospital discharge but not delayed cholecystectomy

J Trauma Acute Care Surg 74:175-179; discussion 179-80. Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, ON, Canada BACKGROUND: Current data on the clinical […]

Primary care safety-net delivery sites in the United States: A comparison of community health centers, hospital outpatient departments, and physicians’ offices

JAMA 284:2077-2083. Department of Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, MD, USA CONTEXT: The US primary care safety net is […]

Psychiatric illness and subsequent traumatic brain injury: a case control study

J Neurol Neurosurg Psychiatry 72:615-620. Department of Psychiatry, University of Washington, Seattle, WA, USA OBJECTIVE: To determine whether psychiatric illness is a risk factor for […]

Population-based medical and disease management: an evaluation of cost and quality

Dis Manag 9:45-55. UMHS Medical Management Center, University of Michigan, Ann Arbor, MI, USA Reports by the Institute of Medicine and the Health Care Financing […]

Regression tree boosting to adjust health care cost predictions for diagnostic mix

Health Serv Res 43:755-772. Healthcare Management and Statistical Consulting, 4303 Stanford Street, Chevy Chase, MD, USA OBJECTIVE: To assess the ability of regression tree boosting […]

The contribution of longitudinal comorbidity measurements to survival analysis

Med Care 47:813-821. Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA BACKGROUND: Many clinical and health services research studies are […]

Income inequities in end-of-life health care spending in British Columbia, Canada: A cross-sectional analysis, 2004-2006

Int J Equity Health 10:12. Centre for Health Services and Policy Research, University of British Columbia, Vancouver BC, Canada BACKGROUND: This study aimed to measure […]

Selection bias explains apparent differential mortality between dialysis modalities

Selection bias explains apparent differential mortality between dialysis modalities. J Am Soc Nephrol 22:1534-1542. University of Calgary, Calgary, AB, Canada The relative risk of death […]

Tracking family medicine graduates. Where do they go, what services do they provide and whom do they see?

BMC Fam Pract 13:26. Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada BACKGROUND: There are continued concerns over an adequate supply […]

Cost analysis of adding pregabalin or gabapentin to the management of community-treated patients with peripheral neuropathic pain

J Eval Clin Pract 18:1170-1179. Badalona Serveis Assistencials, Badalona, Barcelona, Spain OBJECTIVE: To compare the cost of adding either pregabalin or gabapentin to the management […]

A new simple primary care morbidity score predicted mortality and better explains between practice variations than the Charlson index

J Clin Epidemiol 66:436-444. Population Health Research Centre, Division of Population Health Sciences and Education, St George’s University of London, London, UK OBJECTIVES: Adjustment for […]

Doctor shopping by overweight and obese patients is associated with increased healthcare utilization

Obesity 21:1328-1334. Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. OBJECTIVE: Negative interactions with healthcare providers […]

Patient poverty and workload in primary care: study of prescription drug benefit recipients in community health centres

Can Fam Physician 59:384-390. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada Erratum in: Can Fam Physician. 2013 Jun;59(6):612. OBJECTIVE: To […]

Adverse events recorded in English primary care: observational study using the General Practice Research Database

Br J Gen Pract 63:534-542. Department of Primary Care and Public Health (DPCPH), Imperial College London, London, UK BACKGROUND: More accurate and recent estimates of […]

The roles of primary care PAs and NPs caring for older adults with diabetes

JAAPA 27:45-49. Duke University School of Medicine, Durham, NC; Veterans Affairs Pittsburgh Healthcare System and University of Pittsburgh School of Pharmacy, Pittsburgh, PA; University of […]

Profiling resource use by primary-care practices: managed Medicare implications

Health Care Financ Rev 17:23-42. Project HOPE Center for Health Affairs, Bethesda, MD, USA Variations in elderly Medicare beneficiaries’ health service use are examined using […]

Evaluating case-mix and predictive modeling measures within the British primary care sector

BMC Health Serv Res 7:A8. Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Imperial College London, UK Aim: The goal of this project […]

Clinical analytics and data management for the DNP

New York, NY, USA: Springer. Johns Hopkins Health Care, Glen Burnie, MD, USA Strong data management knowledge and skills are a requirement for every DNP. […]

Using case finding and risk stratification: a key service component for personalised care and support planning

London, UK: National Health Service. National Health Service. London, UK This handbook describes current thinking and provides practitioner insights into case finding and risk stratification […]

Population profiling in Slough CCG

Windsor, UK: NHS Slough Clinical Commissioning Group. NHS Slough Clinical Commissioning Group, Windsor, UK As our population ages and the prevalence of long term conditions […]

Editorial: Managing costs with software. Advance for Health Information Executives

Advance Newsmagazines, King of Prussia, PA, USA More than two years ago when Dave Ford took over as CEO at CareOregon in Portland, Ore., the […]

Validation and uses of the ACG-DX predictive modeling and risk adjustment tool in an Israeli HMO

Clin Med Res 8:51-52. Maccabi Healthcare Services, Tel Aviv, Israel BACKGROUND: With an ever increasing population of HMO members with chronic disease and continuing economic […]

The additional cost of chronic disease in Manitoba

Winnipeg, MB, Canada: Manitoba Centre for Health Policy. Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB, Canada Many Manitobans have a chronic disease—indeed […]

A comparative analysis of methods of health risk assessment: final report

Cambridge, MA, USA: Harvard University School of Public Health. Harvard University School of Public Health, Cambridge, MA, USA A key component of many recent proposals […]

Implementing risk assessment and risk adjustment for people with disabilities in state programs: six case studies

Washington, DC, USA: NRH Center for Health and Disability Research. NRH Center for Health & Disability Research, Washington, DC, USA As a group, people with […]

A comparative analysis of claims-based tools for health risk assessment

Schaumburg, IL, USA: Society of Actuaries. Japanese translation published by Tokyo Gakugei University. Society of Actuaries, Schaumburg, IL, USA This Society of Actuaries research project […]

Capitation payment systems – risk factor estimation

Academia Economic Papers 28:231-261. Published in Chinese. PURPOSE: To explore risk factors that can explain individual medical expenditure. SAMPLE: Subjects included in “1996 NHI Satisfaction […]

Managing the gap: evaluating the impact of Medicaid managed care on service use and disparities in health care access

Baltimore, MD, USA: University of Maryland (doctoral dissertation). University of Maryland, Baltimore, MD, USA The National Institutes of Health (NIH) define a health disparity as […]

Identifying patients with high pharmacy consumption by using the Adjusted Clinical Groups in a primary care setting

European Neuropsychopharmacology 19:S340-S341. Badalona Serveis Assistencials SA, Directorate ofPlanning, Badalona. Barcelona, Spain BACKGROUND: Prescription drug costs are rapidly increasing in most countries. The pharmaceutical expenditure […]

Plataforma de proces de dades d’atencio primaria

Barcelona, Spain: Universitat Politecnica de Catalunya (masters thesis). Published in Catalan. Universitat Politecnica de Catalunya, Spain No abstract

Measuring the casemix of physician practices in primary-care reform models in Ontario, Canada

BMC Health Serv Res 11:A22. Institute for Clinical Evaluative Sciences, Toronto, ON, Canada INTRODUCTION: A number of different blended-payment models for primary- care delivery have […]

Patients with chronic illness in the patient-centered medical home: costs, use, quality and morbidity-based variation

Seattle, WA, USA: University of Washington (doctoral dissertation). University of Washington, Seattle, WA, USA Originally described in 1967 as a central source of a medical […]

Evaluation of the full service family practice incentive program and the practice support program: synthesis report for work completed to June 2013

Victoria, BC, Canada: Hollander Analytical Services Ltd. This report constitutes a synthesis of findings from the evaluation of the Full Service Family Practice Incentive Program […]

Kan casemix-systemer anvendes i den danske primaersektor?

Odense, Denmark: Syddansk Universitet. Published in Danish. Syddansk University, Odense, Denmark Dette arbejdspapir er udarbejdet af Forskningsenheden for Almen Praksis (FEA) og Center for Sundhedsøkonomisk […]

Population-based Study of the Effect of Free Influenza Vaccination on Medical Utilization of Elderly

National Yang Ming University A Population-based Study of the Effect of Free Influenza Vaccination on Medical Utilization of Elderly Taiwanese Ching Wen Chien, Ph.D.

Population risk stratification to support strategic planning and commissioning

NHS Midlands and Lancashire Commissioning Support Unit Population Level Risk Stratification to Support Strategic Planning and Commissioning  

Wednesday(C9)-The Creation of New Models to Predict Future Resource Use and Risk of Hospital Admission for a General Population in NHS England —Stephen Sutch

The Creation of New Models to Predict Future Resource Use and Risk of Hospital Admission for a General Population in NHS England —Stephen Sutch, Johns […]

Tuesday(C7)-Development of the case finding tool using the ACG system-Roberts

Development of the case finding tool using the ACG system Kevin Roberts

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Readmissions: What Health Plans Need to Know

Preventing avoidable hospital readmissions is considered by many to be the most important opportunity for reducing waste in health care. This podcast explains readmissions and why identifying these at-risk patients is important to health plans. Learn more.

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Case Mix Adjustment Case Study – Payer

This Case Study shows how Leicester City CCG, one of the most ethnically diverse areas of the UK, analyzed emergency admission rates for all practices, to learn that practices with lower emergency admission rates had significantly higher coding completeness and GP patient survey scores. Learn more.

Variation in Access to Kidney Transplantation across Renal Programs in Ontario, Canada

In the United States kidney transplant rates vary significantly across end-stage renal disease (ESRD) networks. We conducted a population-based cohort study to determine whether there […]

A case-mix classification system for explaining healthcare costs using administrative data in Italy

Abstract Background The Italian National Health Service (NHS) provides universal coverage to all citizens, granting primary and hospital care with a copayment system for outpatient […]

Attitudes and behaviour towards psychotropic drug prescribing in Swedish primary care: a questionnaire study

Abstract Background The prescribing of psychotropic drugs, i.e. antidepressants, sedatives (anxiolytics, hypnotics), and antipsychotics is considerable and a large proportion is prescribed by general practitioners […]

Association between allopurinol and cardiovascular outcomes and all‐cause mortality in diabetes: A retrospective, population‐based cohort study

Abstract Aim To assess the association between allopurinol and mortality and cardiovascular outcomes in an allopurinol‐treated diabetes cohort. Materials and Methods We conducted a population‐based […]

Patient- and hospital-level predictors of vancomycin-resistant Enterococcus (VRE) bacteremia in Ontario, Canada

Abstract   Background Data are limited on risk factors for vancomycin-resistant Enterococcus (VRE) bacteremia. Methods All patients with a confirmed VRE bacteremia in Ontario, Canada, between January […]

When the Doctor-Patient Divide Is a Chasm

Abstract For an important group of patients, the divide between themselves and their healthcare team is a chasm. These patients are variously identified in different […]

Health of Spanish centenarians: a cross-sectional study based on electronic health records

Abstract Background With the number of centenarians increasing exponentially in Spain, a deeper knowledge of their socio-demographic, clinical, and healthcare use characteristics is important to […]

A cross-sectional study of prolonged disengagement from clinic among people with HCV receiving care in a low threshold, multidisciplinary clinic

Abstract Background Disengagement from care can affect treatment outcomes of patients with hepatitis C virus (HCV). We assessed the extent and determinants of disengagement among […]

The direct healthcare costs attributable to West Nile virus illness in Ontario, Canada: a population-based cohort study using laboratory and health administrative data

Abstract Background West Nile virus (WNV) is a mosquito-borne flavivirus, first detected in the Western Hemisphere in 1999 and spread across North America over the […]

Objective Estimates of Direct-Medical Costs Among Persons Aged 3 to 38 Years With and Without Research-Defined Autism Spectrum Disorder Ascertained During Childhood: A Population-Based Birth-Cohort Study

Abstract Objectives Accurate estimates of autism spectrum disorder (ASD)–associated medical costs are essential for predicting future care needs, allocating resources, identifying best practices, and modeling […]

Healthcare Service Usage and Costs for Elderly Patients with Obstructive Lung Disease

Abstract Background The worldwide prevalence of obstructive lung disease (OLD) is increasing, especially among people >65 years old, and nearly three in four adults with […]

Multimorbidity clusters in patients with chronic obstructive airway diseases in the EpiChron Cohort

Abstract Objectives Chronic obstructive airway diseases such as chronic obstructive pulmonary disease (COPD), asthma, rhinitis, and obstructive sleep apnea (OSA) are amongst the most common […]

Association between neuraxial anaesthesia or general anaesthesia for lower limb revascularisation surgery in adults and clinical outcomes: population based comparative effectiveness study

Abstract Objective To examine the associations between neuraxial anaesthesia or general anaesthesia and clinical outcomes, length of hospital stay, and readmission in adults undergoing lower […]

Early Surgical Complications of Total Hip Arthroplasty in Patients With Morbid Obesity: Propensity-Matched Cohort Study of 3683 Patients

Abstract Background The aim of this study is to determine whether the high risk of surgical complications within 1 year of total hip arthroplasty (THA) […]

Health service utilization in immigrants with multiple sclerosis

Abstract Background Access to neurology specialty care can influence outcomes in individuals with multiple sclerosis (MS), but may vary based on patient sociodemographic characteristics, including […]

Immediate and Long-Term Health Care Support Needs of Older Adults Undergoing Cancer Surgery: A Population-Based Analysis of Postoperative Homecare Utilization

Abstract Background Functional outcomes are central to decision-making by older adults (OA), but long-term risks after cancer surgery have not been described beyond 1 year for […]

Development of measurable criteria to identify and prioritize patients for inclusion in comprehensive medication management programs within primary care settings

ABSTRACT BACKGROUND Pharmacists optimize medication use and ensure the safe and effective delivery of pharmacotherapy to patients using comprehensive medication management (CMM). Identifying and prioritizing […]

Impact of frailty on inpatient outcomes in thyroid cancer surgery: 10-year results from the U.S. national inpatient sample

Abstract Background Frailty is linked to perioperative morbidity and mortality. We evaluated the impact of preoperative frailty on inpatient outcomes of patients undergoing surgery for […]

New Opioid Use and Risk of Emergency Department Visits Related to Motor Vehicle Collisions in Ontario, Canada

Abstract Importance Opioids can impair motor skills and may affect the ability to drive; however, the association of opioid use with driving ability is not […]

Impact of a patient-centered care model implemented in public health facilities in Chile: A real world evidence evaluation

Abstract Objective Health systems face multimorbidity as the leading cause of the burden of disease and demand for healthcare services. Although non-communicable diseases are well […]

Comparing and validating medication complexity from insurance claims against electronic health records

ABSTRACT BACKGROUND Patient effort to comply with complex medication instructions is known to be related to nonadherence and subsequent medical complications or health care costs. […]

Surgeon factors but not hospital factors associated with length of stay after colorectal surgery – A population based study

Abstract Aim Length of stay (LOS) after colorectal surgery (CRS) is a significant driver of healthcare utilization and adverse patient outcomes. To date, there is […]

Predicting Health Utilities Using Health Administrative Data: Leveraging Survey-linked Health Administrative Data from Ontario, Canada

Abstract Background The quality-adjusted life year (QALY) is widely used to measure health outcome that combines the length of life and health-related quality of life […]

Outcomes following exposure to drug interactions with ibrutinib in patients with chronic lymphocytic leukaemia

Summary Ibrutinib is metabolized by cytochrome P450 3A (CYP3A) and poses challenges with drug interactions. We conducted a population-based cohort study of Ontario residents aged […]

Can the Care Need Index Identify Healthcare Centres With Higher Proportions of Children at Risk?

ABSTRACT Aims To examine the association between the widely used social deprivation index, the Child Adjusted Care Need Index, and healthcare centres with a higher […]

The Impact of Social Determinants of Health on Treatment Received in Patients with Stage I Lung Cancer in Ontario: A Population-Based Analysis

Abstract Surgical resection is recommended for operable stage I non-small-cell lung cancer (NSCLC), while radiotherapy reserved for inoperable patients. Very comorbid patients may receive no […]

Psychiatric hospitalizations among Canadian Armed Forces Veterans and former Royal Canadian Mounted Police members residing in Ontario: A retrospective cohort study

Abstract Objectives Canadian Armed Forces (CAF) Veterans and former Royal Canadian Mounted Police (RCMP) members (“Veterans/former RCMP members”) may be at increased risk of mental […]

Treatment-modifying effects of frailty on stroke reperfusion therapy outcomes: a systematic review and meta-analysis

Abstract Background Frailty is common amongst individuals presenting with acute ischaemic stroke (AIS). Not only has frailty been found to have disease-modifying effects in terms […]

Patient-Reported Symptom Burden and Temporal Trends During the First 18 Months After Gynecologic Cancer Diagnosis: A Population-Based Study

Abstract Objectives: Our objectives were to evaluate symptom prevalence, severity, and temporal trends ≤ 18 months from gynecologic cancer (Gyn-Ca) diagnosis using the ESAS-r questionnaire […]

Using Personas as a Tool for People-Centred Segmentation and Health Systems Planning in Ontario, Canada

Abstract Introduction: Health systems are increasingly using population segmentation for planning to organise populations into segments with similar health characteristics. However, given that these data-driven approaches […]

Association of a Care Coordination Model With Health Care Costs and Utilization The Johns Hopkins Community Health Partnership (J-CHiP)

Abstract Importance  The Johns Hopkins Community Health Partnership was created to improve care coordination across the continuum in East Baltimore, Maryland. Objective  To determine whether the Johns […]

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Case Management and Care Coordination Part 1

This webinar will provide an overview of the data available within the ACG System to support case finding activities. The topics covered will include the […]

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Case Mix Adjustment in Primary Care

Presented by: Dr. David Shepherd FRCGP

This webinar shares a case study of Leicester CCG in the UK. The ACG System was used to analyze emergency admission rates for all practices in the area. The top 8 practices were identified and studied further to understand key characteristics of those practices.

Developing a dashboard to help measure and achieve the triple aim: a population-based cohort study

BMC Health Serv Res 14:363. McMaster University, Hamilton, ON, Canada BACKGROUND: Health system planners aim to pursue the three goals of Triple Aim: 1) reduce […]

Performance of the ACG case-mix system in two Canadian provinces.

Med Care 39:86-99. Centre for Health Services and Policy Research, University of British Columbia, Vancouver, BC, Canada BACKGROUND: While the adjusted clinical group (ACG) system […]

Identifying possible indicators of systematic overuse of health care procedures with claims data

Med Care 52:157-163. Department of Health Policy and Management, Johns Hopkins University, Baltimore, MD, USA BACKGROUND: Health care quality is frequently described with measures representing […]

Evaluating diagnosis-based case-mix measures: how well do they apply to the VA population?

Med Care 39:692-704. Center for Health Quality, Outcomes and Economic Research, Bedford VAMC, MA, USA BACKGROUND: Diagnosis-based case-mix measures are increasingly used for provider profiling, […]

The association between continuity of care and the overuse of medical procedures

JAMA Intern Med Johns Hopkins University, Baltimore, MD, USA Importance: Both the overuse of unnecessary medical procedures and poor continuity of care are thought to […]

Effect of attribution length on the use and cost of health care for a pediatric Medicaid Accountable Care Organization

JAMA Pediatr 170:148-154. Children’s Hospitals and Clinics of Minnesota, Minneapolis, MN, USA IMPORTANCE: Little is known about the effect of pediatric accountable care organizations (ACOs) […]

Factors associated with acute care use among nursing home residents dying of cancer: a population-based study

Int J Palliat Nurs 21:349-356. McMaster University, Hamilton, ON, Canada BACKGROUND: Little is known about residents of long-term care (LTC) facilities who die of cancer. […]

Predictors of opioid-related death during methadone therapy

J Subst Abuse Treat 57:30-35. University of Toronto, ON, Canada; Institute for Clinical Evaluative Sciences, Toronto, ON, Canada; St. Michael’s Hospital, Toronto, ON, Canada; St. […]

The potential for community-based health information exchange systems to reduce hospital readmissions

J Am Med Inform Assoc 22:435-442. Weill Cornell Medical College, New York, NY, USA BACKGROUND: Hospital readmissions are common, costly, and offer opportunities for utilization […]

Fifty years of pediatric asthma in developed countries: how reliable are the basic data sources?

Pediatr Pulmonol 47:211-219. British Columbia’s Children’s Hospital, Vancouver, BC, Canada Given the difficulties in diagnosing, or even defining, asthma in children, claims of a pediatric […]

Application of the Ambulatory Care Groups in the primary care of a European national health care system: does it work?

Med Care 37:238-248. Astrabudúa Health Center, Osakidetza/Basque Health Service, Bizkaia, Spain BACKGROUND: Ambulatory Care Groups (ACGs), a US case mix system that uses the patient […]

Quality assessment: is the focus on providers or on patients?

Int J Qual Health Care 8:231-241. Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA Most studies of ambulatory care quality are based on chart […]

Biphasic fracture risk in diabetes: a population-based study

Bone 40:1595-1601. Department of Medicine, University of Manitoba, Winnipeg, MB, Canada Diabetes is associated with increased fracture rates but the effect size, time course and […]

The comorbidity burden of the treated asthma patient population in British Columbia

Chronic Dis Can 30:46-55. University of British Columbia, Faculty of Pharmaceutical Sciences, Vancouver, BC, Canada To date there has been little investigation of the prevalence […]

Nonparticipation in a population-based trial to increase colorectal cancer screening

Am J Prev Med 42:390-397. Group Health Permanente, University of Washington Medical School, Seattle, WA, USA BACKGROUND: Many trials have tested different strategies to increase […]