papers

Characteristics of adult primary care patients as predictors of future health services charges

Med Care 39:1170-1181.

Department of Community and Family Medicine, Duke University Medical Center, Durham, NC, USA

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.

RESEARCH DESIGN: 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.

SUBJECTS: Adult primary care patients.

MEASURES: 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.

PMID: 11606871