The Impact of Patient Complexity on Healthcare Utilization

NCT03327896 | Unknown

• 1 other identifier: HSD-1603-34987
• Study Type: observational
• Target: 200,000
• Locations: 0 countries
• Sites: N/A

Brief 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.

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

Keywords

Quality Measures, Social Determinants of Health

Outcome Measures

Primary Outcomes (1)

• Provider Ranking as Assessed by Health Care Quality Metrics

  Comparison of adjusted provider quality rankings with metrics adjusted for Charlson Morbidity Scores and Patient Panel Neighborhood Deprivation Indicators

  1 year (2015)

Secondary Outcomes (6)

• Well Child Visits in first 15 Months of life (patient level)

  15 months

• Screening for alcohol and drug misuse (patient level)

  1 year (2015)

• Emergency Department Visits (Patient level)

  1 year (2015)

• Avoidable Emergency Department Visits (Patient level)

  1 year (2015)

• Uncontrolled Hemoglobin A1c in Diabetics (patient level)

  1 year

Study Arms (4)

OCHIN EHR

Patients who were established patients at OCHIN Primary Care Clinics in 2015 and had a face to face visit at the clinic in 2015. Inclusion criteria for specific outcomes varies by criteria for demoninator specification for the metric.

Other: Charlson score and Community Social Deprivation

OneFlorida EHR

Patients who were established patients at OneFlorida Primary Care clinics in 2015 and had a face to fact visit at the clinic in 2015. Inclusion criteria for specific outcomes varies by criteria for demoninator specification for the metric.

Other: Charlson score and Community Social Deprivation

Oregon Medicaid

Clients who were continuously insured through Oregon Medicaid in 2015 and had a claim with an Evaluation and Management Current Procedure Terminology (CPT) code indicating an office visit listing a Primary Care provider as the performing provider. Inclusion criteria for specific outcomes varies by criteria for demoninator specification for the metric.

Other: Charlson score and Community Social Deprivation

Florida Medicaid

Clients who were continuously insured through Florida Medicaid in 2015 and had a claim with an Evaluation and Management Current Procedure Terminology (CPT) code indicating an office visit listing a Primary Care provider as the performing provider. Florida Medicaid data is limited to clients who were 22 years or younger. Inclusion criteria for specific outcomes varies by criteria for demoninator specification for the metric.

Other: Charlson score and Community Social Deprivation

Interventions

Charlson score and Community Social Deprivation OTHER

This is an observational study of the association of clinical comorbidity and neighborhood social deprivation characteristics with healthcare performance assessment.

Florida Medicaid; OCHIN EHR; OneFlorida EHR; Oregon Medicaid

Eligibility Criteria

• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)
• Sampling Method: Non-Probability Sample

Study Population

Stage 1 (Patient Level): Established patients of primary care providers with a visit in 2015 Stage 2 (Provider level): Primary Care providers with at least 20 patients from established patients in 2015 Stage 3 (Clinic level): Primary care Clinics

Sponsors & Collaborators

• OCHIN, Inc.: lead
• University of Florida: collaborator

Related Publications (1)

• Hughes LS, Phillips RL Jr, DeVoe JE, Bazemore AW. Community Vital Signs: Taking the Pulse of the Community While Caring for Patients. J Am Board Fam Med. 2016 May-Jun;29(3):419-22. doi: 10.3122/jabfm.2016.03.150172.

  PMID: 27170802 BACKGROUND

Related Links

• Article abstract

Study Officials

• Abigail Sears, MBA

  OCHIN, Inc.

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: observational
• Observational Model: CASE ONLY
• Time Perspective: RETROSPECTIVE
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: October 27, 2017
• First Posted: November 1, 2017
• Study Start: January 15, 2017
• Primary Completion: August 1, 2017
• Study Completion: August 1, 2018
• Last Updated: November 1, 2017

Record last verified: 2017-10

Data Sharing

• IPD Sharing: Will not share