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Using risk adjustment approaches in child welfare performance measurement: applications and insights from health and mental health settings

Child Youth Serv Rev 32:103-112. Washington University in St. Louis, St. Louis, MO, USA Federal policymaking in the last decade has dramatically expanded performance measurement […]

Predicting the financial risks of seriously ill patients

Sacramento, CA, USA: California Health Care Foundation. In this paper, a Medical Productivity Index (MPI) is proposed as such a metric to capture the value […]

Empirical studies in the economics of health insurance, health, and fertility

Princeton, NJ, USA: Princeton University (doctoral dissertation) Princeton University, Princeton, NJ, USA This thesis is a collection of essays in the economics of health insurance, […]

A simple but efficient approach to the analysis of multilevel data

Health Economics Papers 2013:6. Odense, Denmark: University of Southern Denmark. University of Southern Denmark, Odense, Denmark Much research in health economics revolves around the analysis […]

Adjusted clinical groups: a patient classification system through risk adjustment

Rev Peru Med Exp Salud Publica 30:308-314. Published in Spanish. Directorate of Planning, Badalona Serveis Assistencials SA, Badalona, Spain Adjusted Clinical Groups (ACG) are risk […]

High-Risk Case Identification for Use in Comprehensive Complex Care Management

 High-Risk Case Identification for Use in Comprehensive Complex Care ManagementBecause patients with multiple chronic conditions require proactive, coordinated care management to effectively manage numerous health […]

Population Health Management through Care Coordination and Interventions

Population health management at JHHC represents a comprehensive approach to health care considering the distribution of health outcomes within a population, and the health determinants […]

Casemix and Quality

Hospital Authority Casemix and Quality – Are they rivals or partners? Dr. K.H. Lee

Tuesday-Managing hospitalization risk-Terry and Oberg

Dovetail Managing Hospitalization Risk: Refining Patient Selection in a Care Transitions Program Lara Terry, MD. Jeff Oberg

Monday-US Health Reform-Abrams

Johns Hopkins ACG System Using ACGs to Support Risk Adjusted Premiums within the Health Insurance Exchange Chad Abrams

Monday-Advances in modeling risk-Thibodeau

Medica Leveraging the John Hopkins ACG Tool to Support Total Cost of Care Contracts Peter M. Thibodeau

Implementing the ACG risk within NHS

NHS Airedale, Bradford & Leeds Cluster Information Services Implementing the ACG risk of hospitalization model with NHS data: experiences from Leeds Dr Thomas Mason MA., […]

Using Predictive Modeling to Identify Readmission Risk

Johns Hopkins Bloomberg School of Public Health Using Predictive Modeling to Identify Readmission Risk K. Lemke

Monday(C3)-Geographically Identifying Expanded Diagnosis Clusters in the Hispanic/Latino Population —Thomas Ludden

Geographically Identifying Expanded Diagnosis Clusters in the Hispanic/Latino Population  —Thomas Ludden, Carolinas Healthcare System  

Wednesday(C9)-Swinging from a new tee – towards ‘The Extended Epidemiology’ by analysing the outcome from ACG processing in a County Council in Sweden

Swinging from a new tee – towards ‘The Extended Epidemiology’ by analysing the outcome from ACG processing in a County Council in Sweden —Ulf Börjesson, […]

Care Density: Amy Salls, DST Health Solutions

ACG System DST Health Solutions Care Density Amy Salls

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The ACG System as a Common Language

Chad Abrams, Director of U.S. Operations, ACG System; describes common challenges around the world such as language differences, data quality, turning data into impact, and […]

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Segmentation Case Study

Slough Clinical Commissioning Group (CCG), which covers a population of 143,000 in the UK, used the Johns Hopkins ACG System to conduct a population health analysis that generated several new insights. After just 18 months, unplanned hospitalizations were reduced by 18% and emergency department visits were reduced by 19%.

Incident atrial fibrillation in the emergency department in Ontario: a population-based retrospective cohort study of follow-up care

CMAJ Open 3:E182. Institute for Clinical Evaluative Sciences, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada BACKGROUND: Continuity of care has been shown to […]

Comprehensive preventive care assessments for adults with intellectual and developmental disabilities in Ontario – Part 2: 2003-2014

Objective To determine if there has been an increase in preventive care among adults with IDD as a result of the publication of the Canadian […]

Association between method of pelvic organ prolapse repair involving the vaginal apex and re-operation: a population-based, retrospective cohort study

Abstract Introduction and hypothesis Vaginal apical suspension is essential for the surgical treatment of pelvic organ prolapse (POP). We aim to evaluate whether the method […]

Patient-reported symptoms following mastectomy alone or lumpectomy plus radiation for early stage breast cancer: a cohort study

Abstract Purpose Studies examining symptom differences between surgeries for breast cancer patients rarely incorporate the effects of adjuvant treatment choice. We sought to understand differences […]

Rapid repeat pregnancy among women with intellectual and developmental disabilities: a population-based cohort study

Abstract   BACKGROUND Rapid repeat pregnancy within 12 months of a live birth is associated with adverse perinatal outcomes. We evaluated the risk for rapid […]

Comparing Survey-Based Frailty Assessment to Medicare Claims in Predicting Health Outcomes and Utilization in Medicare Beneficiaries

Abstract   Objectives To assess two models for the prediction of health utilization and functions using standardized in-person assessments of frailty and administrative claims-based geriatric […]

Association of Care Management Intensity With Healthcare Utilization in an All-Condition Care Management Program

ABSTRACT Objectives: To identify care needs among Medicaid and Medicare patients in an all-condition care management program involving case managers (CMs) and community health workers (CHWs), […]

One-Year Mortality After Emergency Department Visit for Nonfatal Opioid Poisoning: A Population-Based Analysis

Abstract Study objective We aim to characterize the incidence and risk factors for opioid-related and all-cause mortality in the year after an emergency department (ED) […]

Colonoscopy resource availability and its association with the colorectal cancer diagnostic interval: A population‐based cross‐sectional study

Abstract Background Colonoscopy is a key resource used to diagnose colorectal cancer (CRC). This study evaluated the relationship between colonoscopy availability and the length of […]

Variation in care of patients with elderly-onset inflammatory bowel disease in Ontario, Canada: A population-based cohort study

Abstract Background Variation in health care, when not based on patient preference, may result in poorer care. We determined whether variation in health services utilization, […]

Mental Health Services Provision in Primary Care and Emergency Department Settings: Analysis of Blended Fee-for-Service and Blended Capitation Models in Ontario, Canada

Abstract Treating mental illnesses in primary care is increasingly emphasized to improve access to mental health services. Although family physicians (FPs) or general practitioners are […]

Impact of Frailty on Clinical Outcomes after Carotid Artery Revascularization

Abstract Objectives : Frailty has been increasingly recognized as an important risk factor for vascular procedures. To assess the impact of frailty on clinical outcomes and […]

Health Status of Females Who Experience Incarceration: A Population-Based Retrospective Cohort Study

Abstract Background People who experience incarceration have poor health across a variety of indicators, but we lack population-level data on the health of females in […]

Concurrent hiatal hernia repair and bariatric surgery: outcomes after sleeve gastrectomy and Roux-en-Y gastric bypass

Abstract Background Hiatal hernias are often repaired concurrently with bariatric surgery to reduce risk of gastroesophageal reflux disease–related complications. Objectives To examine the association between […]

Explanatory Ability of the ACG System Regarding the Utilization and Expenditure of the National Health Insurance Population in Taiwan—A 5-year Analysis

ABSTRACT Background The adjusted clinical group (ACG) is a diagnosis-based case-mix adjustment system, which has been widely evaluated in several countries other than Taiwan. The […]

Impact of Frailty on Clinical and Financial Outcomes Following Minor Lower Extremity Amputation: A Nationwide Analysis

Abstract Objective Frailty has been shown to portend worse outcomes in surgical patients. Our goal was to identify the impact of frailty on outcomes and […]

Predicting Future Health Risk in COPD: Differential Impact of Disease-Specific and Multi-Morbidity-Based Risk Stratification

Abstract Objective Multi-morbidity contributes to mortality and hospitalisation in COPD, but it is uncertain how this interacts with disease severity in risk prediction. We compared […]

A Population-Based Analysis of Long-Term Outcomes Among Older Adults Requiring Unexpected Intensive Care Unit Admission After Cancer Surgery

Abstract Background High-intensity cancer surgery is increasingly common among older adults. However, these patients are at high-risk for unexpected intensive care unit (ICU) admissions after […]

Pain and haemorrhage are the most common reasons for emergency department use and hospital admission in adults following ambulatory surgery: results of a population-based cohort study

Abstract Background Advances in healthcare delivery have allowed for the increase in the number of ambulatory surgery procedures performed in Canada. Despite these advances, patients […]

Intensive Use of Forensic Inpatient Services by People with Intellectual and Developmental Disabilities in Ontario, Canada: Prevalence and Associated Characteristics

Abstract Background People with intellectual/developmental disabilities (IDD) are reportedly intensive users of forensic inpatient services. Methods Using administrative data, we identified people with and without […]

Outcomes of SARS-CoV-2 infection in cancer versus non-cancer-patients: A population-based study in northeastern Italy

Abstract Introduction This study assesses the risk of infection and clinical outcomes in a large consecutive population of cancer and non-cancer patients tested for SARS-CoV-2 […]

The impact of frailty on adjuvant treatment in patients with head and neck free flap reconstruction—A retrospective study using two independent frailty scores

Abstract Objectives Reconstructive surgery may result in prolonged postoperative recovery, especially in frail patients, which in turn may impact delivery of adjuvant therapy. To date, […]

Health Care Utilization among Adult Survivors of Childhood and Adolescent Cancer in Ontario

Abstract Survivors of childhood and adolescent cancers are at increased risk for late effects including subsequent cancer, cardiotoxicities, and poor psychosocial health. Few studies have […]

Differences in health care costs between two social health support programs: findings from a randomized social health integration pilot program

Abstract Introduction More health systems are implementing strategies to understand and address patient social health, also known as social health integration. We examine the impact […]

Incidence of Respiratory Syncytial Virus-Associated Hospitalization Among Adults in Ontario, Canada, 2017–2019

Abstract Background Respiratory syncytial virus (RSV) causes substantial morbidity and mortality among adults. Given recent RSV vaccine authorizations, data on groups at highest risk are […]

Healthcare utilization patterns and costs related to neurofibromatosis 1 in Ontario, Canada

Abstract Background and objectives Neurofibromatosis type 1 (NF1) is a multisystemic disease, characterized by cutaneous manifestations and peripheral nerve sheath tumors. Patients also have a […]

The effect of frailty on early postoperative outcomes of lobectomy for lung cancer in older adults – A United States National Retrospective Cohort Study

Abstract Introduction Pulmonary lobectomy represents the primary curative treatment for lung cancer in older adults, yet frailty’s impact on critical early postoperative outcomes remains inadequately […]

Comorbidities and Healthcare Utilization in 4197 Patients With Prurigo Nodularis in Israel: A Cross-Sectional Population-Based Analysis

ABSTRACT Background Prurigo nodularis patients face a significant burden of comorbidities, necessitating a comprehensive approach to care. We aimed to explore the association between prurigo […]

Improving Prediction of Risk of Admission to Long-Term Care or Mortality Among Home Care Users With IDD

ABSTRACT Background Frailty is an established predictor of admission into long-term care (LTC) and mortality in the elderly population. Assessment of frailty among adults with […]

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Identifying High-Risk Medicare Advantage Enrollees

Early identification of high-risk members provides the opportunity to manage the complex needs of this population. After one month in the plan, more than 50% […]

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Case Mix Adjustment in Practice

In this webinar, builds upon the introduction to the concept of case mix in the previous webinar and will share how case mix adjustment can […]

Improving the quality of outpatient care for older patients with diabetes: lessons from a comparison of rural and urban communities

J Fam Pract 50:676-680. University of Washington, Department of Family Medicine, Seattle, WA, USA OBJECTIVE: Our goal was to compare the quality of diabetic care […]

Why do physicians vary so widely in their referral rates?

J Gen Intern Med 15:163-168. Department of Family Medicine, University of Rochester, Rochester, NY, USA OBJECTIVE: To determine which physician practice and psychological factors contribute […]

Assessing population health care need using a claims-based ACG morbidity measure: a validation analysis in the province of Manitoba

Health Serv Res 37:1345-1364. Centre for Health Services and Policy Research, University of British Columbia, Vancouver, BC, Canada OBJECTIVES: To assess the ability of an […]

Health care costs, utilization and patterns of care following Lyme disease

PLoS One 10:e0116767. Johns Hopkins Bloomberg University, Baltimore, MD, USA BACKGROUND: Lyme disease is the most frequently reported vector borne infection in the United States. […]

Palliative care and the aggressiveness of end-of-life care in patients with advanced pancreatic cancer

J Natl Cancer Inst 107:p11: kju424. University Health Network, Toronto, ON, Canada; Institute of Medical Sciences, Toronto, ON, Canada BACKGROUND: We examined the impact of […]

Predicting costs of care using a pharmacy-based measure risk adjustment in a veteran population

Med Care 41:753-760. VA Puget Sound Health Care System, Seattle, WA, USA BACKGROUND: Although most widely used risk adjustment systems use diagnosis data to classify […]

Process of care for Medicaid-enrolled children with asthma: served by community health centers and other providers

Med Care 40:303-314. Institute for Health Care Research and Policy, Georgetown Public Policy Institute, Georgetown University, Washington, DC, USA OBJECTIVE: To compare the process of […]

A population-based study evaluating family physicians’ HIV experience and care of people living with HIV in Ontario

Ann Fam Med 13:436-445. Bruyère Research Institute, Ottawa, ON, Canada; University of Ottawa, Ottawa, ON, Canada; Ottawa Hospital Research Institute, Ottawa, ON, Canada; Institute for […]

Sex disparities in post-acute myocardial infarction pharmacologic treatment initiation and adherence: problem for young women

Circ Cardiovasc Qual Outcomes 8:586-592. University of British Columbia, Vancouver, BC, Canada BACKGROUND: The prevalence of the use of secondary prevention cardiovascular medications is lower […]

Increased surgeon experience with rheumatoid arthritis reduces the risk of complications following total joint arthroplasty

Arthritis Rheumatol 66:488-496. University of Toronto and Women’s College Hospital, Toronto, ON, Canada OBJECTIVE: To determine the relationship between surgeon experience with, and complications following, […]

Prevalence, expenditures, and complications of multiple chronic conditions in the elderly

Arch Intern Med 162:2269-2276. Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA BACKGROUND: The prevalence, health care […]

Ambulatory care groups: a categorization of diagnoses for research and management

Health Serv Res 26:53-74. Department of Health Policy and Management, Johns Hopkins School of Hygiene and Public Health, Baltimore, MD, USA This article describes a […]

Using the Johns Hopkins aggregated diagnosis groups (ADGs) to predict mortality in a general adult population cohort in Ontario, Canada

Med Care 49:932-939. Institute for Clinical Evaluative Sciences, Department of Health Management, Policy and Evaluation, University of Ottawa, Ottawa, ON, Canada BACKGROUND: Administrative healthcare databases […]

Preventable hospitalizations and socioeconomic status.

Health Aff 17:177-189. Wagner Graduate School, New York University, New York, NY, USA. “Preventable” hospitalizations have been proposed as indicators of poor health plan performance. […]

Applying diagnosis and pharmacy-based risk models to predict pharmacy use in Aragon, Spain: the impact of a local calibration

BMC Health Serv Res 10:22. Aragon Health Science Institute, Zaragoza, Spain BACKGROUND: In the financing of a national health system, where pharmaceutical spending is one […]

Ambulatory Care Groups and the profiling of primary care physician resource use: examining the application of case mix adjustments

J Ambul Care Manage 19:86-89. Center for Research in Ambulatory Health Care Administration, Englewood, CO, USA A variety of profiling models and tools is utilized […]

Ambulatory specialist use by nonhospitalized patients in us health plans: correlates and consequences

J Ambul Care Manage 32:216-225. Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA Approximately 7 of 10 (and 95% of the elderly) people […]

Impact of comorbidity on the individual’s choice of primary health care provider

Scand J Prim Health Care 29:104-109. Lund University, Department of Clinical Sciences in Malmö, General Practice/Family Medicine, Malmö, Sweden OBJECTIVE. This study examined whether age, […]

Comparing asthma care provided to Medicaid-enrolled children in a primary care case manager plan and a staff model HMO

Ambul Pediatr 3:253-262. Health Policy Institute, Georgetown University, Washington, DC, USA OBJECTIVE: To examine differences in selected processes of asthma care provided to Medicaid-enrolled children […]

Economic profiling of primary care physicians: consistency among risk-adjusted measures

Health Serv Res 39:985-1003. Health Management and Policy, University of Michigan, Ann Arbor, MI, USA OBJECTIVE: To investigate whether different risk-adjustment methodologies and economic profiling […]

Access intervention in an integrated, prepaid group practice: effects on primary care physician productivity

Health Serv Res 43:1888-1905. Department of Health Services, University of Washington, Seattle, WA, USA OBJECTIVE: To estimate the joint effect of a multifaceted access intervention […]

Risk classification of adult primary care patients by self-reported quality of life

Med Care 43:189-193. Department of Community and Family Medicine, Duke University Medical Center, Durham, NC, USA BACKGROUND: Although patient-reported health-related quality of life (HRQOL) is […]

Sleep complaints and their association with comorbidity and health-related quality of life in an older population in Sweden

Aging Ment Health 15:204-213. School of Health Science, Blekinge Institute of Technology, Karlskrona, Sweden OBJECTIVE: The relationship between sleep complaints, comorbidity and health-related quality of […]

Patients with atrial fibrillation and an alternative primary diagnosis in the emergency department: a description of their characteristics and outcomes

Acad Emerg Med 20:193-199. Institute for Clinical Evaluative Sciences, Toronto, ON, Canada OBJECTIVES: Atrial fibrillation is common in the emergency department (ED). Mortality rates at […]

Physical activity and influenza-coded outpatient visits, a population-based cohort study

PLoS One 7:e39518. Institute for Clinical Evaluative Sciences, Toronto, ON, Canada BACKGROUND: Although the benefits of physical activity in preventing chronic medical conditions are well […]

Risk adjustment of capitation payments to behavioral health care carve-outs: how well do existing methodologies account for psychiatric disability?

Health Care Manag Sci 3:159-169. Division of General Internal Medicine and Health Services Research, UCLA Department of Medicine, Los Angeles, CA, USA This study used […]

Pharmaceutical use among older adults: using administrative data to examine medication-related issues

Can J Aging 24 Suppl 1:81-95. Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada Medication use is […]

The effects of complications and comorbidities on the quality of preventive diabetes care: a literature review

Popul Health Manag 11:217-218. Mathematica Policy Research, Washington, DC, USA Although concurrent conditions such as complications and comorbidities are common in people with diabetes, both […]

Cost of arterial hypertension according to levels of morbidity in primary care setting

Med Clin (Barc) 133:290-295. Published in Spanish. Dirección de Planificación, Badalona Serveis Assistencials SA, Badalona, Barcelona, España BACKGROUND AND OBJECTIVE: To determine the health care […]

Case study: the Minneapolis Buyers Health Care Action Group

Inquiry 35:171-177. Health Research Center, Institute for Research and Education, Health System Minnesota, Minneapolis, MN, USA Managed care plans are a type of health insurance. They […]

Physician and patient factors associated with follow up of high grade dysplasias of the cervix: a population-based study

Gynecol Oncol 120:63-67. Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Toronto, Toronto, ON, Canada OBJECTIVE: This population-based study characterizes available physician […]

Comparative ability of comorbidity classification methods for administrative data to predict outcomes in patients with chronic obstructive pulmonary disease

Ann Epidemiol 22:881-887. Institute for Clinical Evaluative Sciences, Toronto, ON, Canada PURPOSE: Administrative healthcare databases are used for health services research, comparative effectiveness studies, and […]

Review of methods used to measure comorbidity in cancer populations: no gold standard exists

J Clin Epidemiol 65:924-933. Cancer Control and Screening Research Group, Department of Public Health, University of Otago, Wellington South, New Zealand OBJECTIVE: This article reviews […]

Evaluating early repeat emergency department use in patients with atrial fibrillation: a population-based analysis

Am Heart J 165:939-948. Institute for Clinical Evaluative Sciences, Toronto, ON, Canada BACKGROUND: Emergency department (ED) use by patients with atrial fibrillation is high and […]

Primary care utilization and mental health diagnoses among adult patients requiring interpreters: a retrospective cohort study

J Gen Intern Med 28:386-391. Office of Women’s Health, Mayo Clinic, Rochester, MN, USA BACKGROUND: Patients requiring interpreters may utilize the health care system differently […]

Association between metformin therapy and mortality after breast cancer: a population-based study

Diabetes Care 36:3018-3026. Women’s College Research Institute, Women’s College Hospital, Toronto, ON, Canada OBJECTIVE: Metformin has been associated with a reduction in breast cancer risk […]

Primary care doctors’ opinion on a risk adjustment system: Adjusted Clinical Groups

Rev Peru Med Exp Salud Publica 30:345-347. Published in Spanish. Directorate of Planning, Badalona Serveis Assistencials SA, Badalona, Spain No abstract

Impact of rheumatoid arthritis on receiving a diagnosis of hypertension among patients with regular primary care

Arthritis Care Res Department of Medicine, Rheumatology Division, University of Wisconsin, Madison, WI, USA OBJECTIVE: Despite numerous studies reporting increased cardiovascular disease (CVD) in patients […]

Comorbidity of dementia: a cross-sectional study of primary care older patients

BMC Psychiatry 14:84. EpiChron Research Group on Chronic Diseases, Aragón Health Sciences Institute (IACS), University Hospital, Zaragoza, Spain BACKGROUND: The epidemiologic study of comorbidities of […]

The impact of morbidity trajectories on identifying high-cost cases: using Taiwan’s National Health Insurance as an example

J Public Health 36:300-307. Department of Health Policy & Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA. BACKGROUND: Incorporating longitudinal information […]

Exploring the Johns Hopkins Aggregated Diagnosis Groups in administrative data as a measure of child health

This study explored the utility of the Johns Hopkins Aggregated Diagnostic Groups (ADGs) as a noncategorical measure of child health in administrative health data. Canadian […]

The hassle of wellness: do peers and health status matter?

In: Population Association of America, eds. 2014 Annual Meeting, Population Association of America. Princeton, NJ, USA: Population Association of America. Cornell University, Ithaca, NY, USA […]

A data-driven approach towards patient identification for telehealth programs

2015 IEEE International Conference on Big Data :2551-2559. Robert Bosch (US), Palo Alto, CA, USA Telehealth provides an opportunity to reduce healthcare costs through remote […]

An actuarial perspective on healthcare expenditure in the last year of life

Washington, DC: International Congress of Actuaries. University of Cape Town, South Africa The aim of this paper is to highlight the key methodological considerations in […]

A hierarchical multivariate two-part model for profiling providers’ effects on health care changes

J Am Statistical Assoc 101:911-923. Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA Procedures for analyzing and comparing health care providers’ effects on […]

Risk adjustment in state Medicaid programs

Health Watch :14-17, 32-34. Denver, Colorado, office of Wakely Consulting Group This article discusses some of the most important considerations in implementing risk adjustment within […]

Health-based risk adjustment: application to premium development and profiling

In: Wrightson CW, eds. Financial strategy for managed care organizations: rate setting, risk adjustment, and competitive advantage. Ann Arbor, MI, USA: Health Administration Press:165-225. Health […]

Evaluation of casemix adjustment methods for the Massachusetts Division of Medical Assistance

Massachusetts Rate Setting Commission. Final report and recommendation. Boston, MA, USA: Massachusetts Rate Setting Commission. Massachusetts Rate Setting Commission, Boston, MA, USA We investigated methods […]

How well do models work? Predicting health care costs

In: American Statistical Association, eds. Proceedings of the Section on Statistics in Epidemiology. Alexandria, VA, USA: American Statistical Association:42-49. Department of General Internal Medicine, Boston […]

A risk stratification model for adult patients with obstructive sleep apnea: development and evaluation

Toronto, ON, Canada: Institute for Clinical Evaluative Sciences. Institute for Clinical Evaluative Sciences, Toronto, ON, Canada STUDY HYPOTHESES: We hypothesize that the apnea-hypopneas index (AHI), […]