Characteristics of adult primary care patients as predictors of future health services charges.
BACKGROUND
Utilization risk assessment is potentially useful for allocation of health care resources, but precise measurement is difficult.


OBJECTIVE
Test the hypotheses that health-related quality of life (HRQOL), severity of illness, and diagnoses at a single primary care visit are comparable case-mix predictors of future 1-year charges in all clinical settings within a large health system, and that these predictors are more accurate in combination than alone.


METHODS
Longitudinal observational study in which subjects' characteristics were measured at baseline, and their outpatient clinic visits and charges and their inpatient hospital days and charges were tracked for 1 year.


METHODS
Adult primary care patients.


METHODS
Duke Health Profile for HRQOL, Duke Severity of Illness Checklist for severity of illness, and Johns Hopkins Ambulatory Care Groups for diagnostic groups classification.


RESULTS
Of 1,202 patients, 84.4% had follow up in the primary care clinic, 63.2% in subspecialty clinics, 14.8% in the emergency room, and 9.6% in the hospital. Of $6,290,775 total charges, $779,037 (12.2%) was for follow-up primary care. The highest accuracy was found for predicting primary care charges, where R2 for predictors ranged from 0.083 for medical record auditor-reported severity of illness to 0.107 for HRQOL. When predictors were combined, the highest R2 of 0.125 was found for the combination of HRQOL and diagnostic groups.


CONCLUSIONS
Baseline HRQOL, severity of illness, and diagnoses were comparable predictors of 1-year health services charges in all clinical sites but most predictive for primary care charges, and were more accurate in combination than alone.
Parkerson
G R
GR
Department of Community and Family Medicine, Duke University Medical Center, Durham, NC 27710, USA. parke001@mc.duke.edu
Harrell
F E
FE
Hammond
W E
WE
Wang
X Q
XQ
D000328:Adult; D000368:Aged; D003953:Diagnosis-Related Groups; D005260:Female; D005544:Forecasting; D015276:Health Care Rationing / Q000379:methods*; D006301:Health Services Needs and Demand / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009657:North Carolina; D011320:Primary Health Care / Q000191:economics* / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011788:Quality of Life; D018570:Risk Assessment / Q000379:methods*; D012720:Severity of Illness Index