NCT03327896

The Impact of Patient Complexity on Healthcare Utilization

• Status: Unknown
• Phase: —
• Study type: Observational
• Enrollment: 200,000 (estimated)
• Sponsor: OCHIN, Inc. · Academic / Other
• Sex: All
• Age: —
• Healthy volunteers: Not accepted

Summary

Healthcare providers are routinely being assessed for metrics designed to assess the quality of the care they deliver. There is growing consensus that these measurements, which typically assess the percentage of patients meeting a specific standard of care, should be adjusted for the clinical complexity of the providers. This study will assess whether adjusting for the social complexity of the patient panel adds significantly to adjustment for clinical complexity in explaining apparent differences in quality of care provided by Primary care providers and clinics.

Detailed description

The analysis will be conducted in 2 stages. In the first stage, indicators of social complexity (as assessed by characteristics of the patients' geocoded addresses) will be tested for significant association with patient level outcomes (meeting or not meeting a specific standard of care). These indicators will be assessed in 4 cohorts: 2 cohorts of patients identified in electronic health records of Clinical Research Networks of community health centers, and 2 cohorts of patients insured by Medicaid in 2015 (Oregon and Florida Medicaid cohorts). Due to limitations in the available data, some quality indicators can only be evaluated in a subset of the cohorts. The consistency of specific social complexity indicators, referred to as Community Vital Signs (CVS), will be evaluated across the cohorts and quality metrics. In the second stage, CVS indicators that contributed consistently to models at the patient level will be evaluated for their effect on provider ranking on quality metrics if the metrics are adjusted for the social complexity of the providers' patient panel in addition to the panels' clinical complexity.

Conditions

• Primary Care Quality Metrics
• Well Child Visits in First 15 Months of Life NQF 1392
• Diabetes Mellitus NQF 0059
• Colorectal Cancer Screening NQF 0034
• Emergency Department Utilization
• Alcohol and Drug Screening

Interventions

Type	Name	Description
OTHER	Charlson score and Community Social Deprivation	This is an observational study of the association of clinical comorbidity and neighborhood social deprivation characteristics with healthcare performance assessment.

Timeline

• Start date: 2017-01-15
• Primary completion: 2017-08-01
• Completion: 2018-08-01
• First posted: 2017-11-01
• Last updated: 2017-11-01