Using a Self-Reported Global Health Measure to Identify Patients at High Risk for Future Healthcare Utilization.
BACKGROUND
Research studies have shown that patient-reported outcome measures (PROMs) that assess global health are helpful for predicting health care utilization, but less evidence exists that collection of PROMs in routine care can identify patients with high health care needs.


OBJECTIVE
To investigate the association between the PROMIS Global Health (PGH) scores and subsequent health care utilization among patients in a large accountable care organization (ACO).


METHODS
Retrospective cohort study of individuals in the Partners HealthCare ACO who completed at least one PGH during a primary care visit.


METHODS
A total of 2639 individuals who completed at least one PGH and who also had 12 months of ACO membership and/or claims data prior to the PROM completion and at least one month of claims data post-PGH completion.


METHODS
The main outcomes were the rates of emergency department (ED) visits and hospitalizations by quartile of PGH physical and mental health scores. We also compared the predictive accuracy of administrative data models with and without the PGH scores to identify the highest utilizers.


RESULTS
The group with the worst (lowest) physical and mental health scores had significantly higher rates of hospitalization (RR 5.14, 95% CI 2.37, 11.15; and 2.27, 95% CI 1.06, 4.85, respectively) than those with higher scores. After adjustment for demographic and clinical factors, only the group with lower physical health scores had higher rates of hospitalization (RR 3.15, 95% CI 1.30, 7.90). The addition of the physical health subscore to administrative data increased the sensitivity to detect the top 5% of hospital utilizers compared with administrative data alone (44.0% vs. 36.0% respectively).


CONCLUSIONS
Worse self-reported physical health, measured during routine primary care, is associated with significantly higher rates of hospitalization. It is not associated with increased rates of ED visits. Self-reported physical health modestly increases the sensitivity to detect the highest hospital utilizers.
Division of General Internal Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA. kblumenthal@partners.org.
Karen J
KJ
Blumenthal
Division of General Internal Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
Yuchiao
Y
Chang
Division of General Internal Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.|Population Health Management, Partners HealthCare, Boston, MA, USA.
Timothy G
TG
Ferris
Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA, USA.
Jenna C
JC
Spirt
Population Health Management, Partners HealthCare, Boston, MA, USA.|Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA, USA.
Christine
C
Vogeli
Population Health Management, Partners HealthCare, Boston, MA, USA.
Neil
N
Wagle
Division of General Internal Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
Joshua P
JP
Metlay
D060866:Accountable Care Organizations / Q000458:organization & administration*; D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006304:Health Status; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D057566:Self Report; D055815:Young Adult
PROMIS Global Health; PROMs (patient-reported outcome measures); health status; patient-centered outcomes research; physical health; risk assessment; utilization