title: Evaluating a Model to Predict Primary Care Physician-Defined Complexity in a Large Academic Primary Care Practice-Based Research Network.
abstract: BACKGROUND
  Improving the ability to risk-stratify patients is critical for efficiently allocating resources within healthcare systems.
  
  
  OBJECTIVE
  The purpose of this study was to evaluate a physician-defined complexity prediction model against outpatient Charlson score (OCS) and a commercial risk predictor (CRP).
  
  
  METHODS
  Using a cohort in which primary care physicians reviewed 4302 of their adult patients, we developed a predictive model for estimated physician-defined complexity (ePDC) and categorized our population using ePDC, OCS and CRP.
  
  
  METHODS
  143,372 primary care patients in a practice-based research network participated in the study.
  
  
  METHODS
  For all patients categorized as complex in 2007 by one or more risk-stratification method, we calculated the percentage of total person time from 2008-2011 for which eligible cancer screening was incomplete, HbA1c was ≥ 9 %, and LDL was ≥ 130 mg/dl (in patients with cardiovascular disease). We also calculated the number of emergency department (ED) visits and hospital admissions per person year (ppy).
  
  
  RESULTS
  There was modest agreement among individuals classified as complex using ePDC compared with OCS (36.7 %) and CRP (39.6 %). Over 4 follow-up years, eligible ePDC-complex patients had higher proportions (p < 0.001) of time with: incomplete cervical (17.8 % vs. 13.3 % for OCS; 19.4 % vs. 11.2 % for CRP), breast (21.4 % vs. 14.9 % for OCS; 22.7 % vs. 15.0 % for CRP), and colon (25.9 % vs. 18.7 % for OCS; 27.0 % vs. 18.2 % for CRP) cancer screening; HbA1c ≥ 9 % (15.6 % vs. 8.1 % for OCS; 15.9 % vs. 6.9 % for CRP); and LDL ≥ 130 mg/dl (12.4 % vs. 7.9 % for OCS; 11.8 % vs 9.0 % for CRP). ePDC-complex patients had higher rates (p < 0.003) of: ED visits (0.21 vs. 0.11 ppy for OCS; 0.17 vs. 0.15 ppy for CRP), and admissions in patients 45-64 and ≥ 65 years old (0.11 vs. 0.10 ppy AND 0.24 vs. 0.21 ppy for OCS).
  
  
  CONCLUSIONS
  Our measure for estimated physician-defined complexity compared favorably to commonly used risk-prediction approaches in identifying future suboptimal quality and utilization outcomes.
authors.affiliation: General Medicine Division, Massachusetts General Hospital, 50 Staniford Street, 9th Floor, Boston, MA, 02114, USA. cshong@partners.org.
authors.forename: Clemens S
authors.initials: CS
authors.lastname: Hong
authors.affiliation: General Medicine Division, Massachusetts General Hospital, 50 Staniford Street, 9th Floor, Boston, MA, 02114, USA.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Atlas
authors.affiliation: General Medicine Division, Massachusetts General Hospital, 50 Staniford Street, 9th Floor, Boston, MA, 02114, USA.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Ashburner
authors.affiliation: General Medicine Division, Massachusetts General Hospital, 50 Staniford Street, 9th Floor, Boston, MA, 02114, USA.
authors.forename: Yuchiao
authors.initials: Y
authors.lastname: Chang
authors.affiliation: General Medicine Division, Massachusetts General Hospital, 50 Staniford Street, 9th Floor, Boston, MA, 02114, USA.
authors.forename: Wei
authors.initials: W
authors.lastname: He
authors.affiliation: General Medicine Division, Massachusetts General Hospital, 50 Staniford Street, 9th Floor, Boston, MA, 02114, USA.
authors.forename: Timothy G
authors.initials: TG
authors.lastname: Ferris
authors.affiliation: Kaiser Permanente Division of Research, Oakland, CA, USA.
authors.forename: Richard W
authors.initials: RW
authors.lastname: Grant
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D000465:Algorithms; D002983:Clinical Competence; D015331:Cohort Studies; D055088:Early Detection of Cancer / Q000706:statistics & numerical data; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008404:Massachusetts; D008875:Middle Aged; D008962:Models, Theoretical; D010346:Patient Care Management / Q000592:standards; D058007:Physicians, Primary Care / Q000592:standards*; D011320:Primary Health Care / Q000592:standards* / Q000706:statistics & numerical data; D018570:Risk Assessment / Q000379:methods