Comparison of physician referral and insurance claims data-based risk prediction as approaches to identify patients for care management in primary care: an observational study

BMC Family Practice

Research Article

Joachim Szecsenyi¹  Tobias Freund¹  Frank Peters-Klimm¹  Stephen Campbell²  Michel Wensing³  Matthias Gondan⁴  Justine Rochon⁴ 

[1] Department of General Practice and Health Services Research, University Hospital Heidelberg, Vossstrasse 2, D-69115, Heidelberg, Germany;Department of General Practice and Health Services Research, University Hospital Heidelberg, Vossstrasse 2, D-69115, Heidelberg, Germany;Centre for Primary Care, Institute for Population Health, University of Manchester, Manchester, UK;Department of General Practice and Health Services Research, University Hospital Heidelberg, Vossstrasse 2, D-69115, Heidelberg, Germany;Centre for Quality of Care Research, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands;Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany;

关键词: Decision support techniques;    Case finding;    Case management;    Disease management;    Primary care;    Multimorbidity;    Avoidable hospitalization;    Prediction;   

DOI  :  10.1186/1471-2296-14-157

 received in 2013-04-11, accepted in 2013-10-11,  发布年份 2013

来源: Springer

【 摘 要 】

BackgroundPrimary care-based care management (CM) could reduce hospital admissions in high-risk patients. Identification of patients most likely to benefit is needed as resources for CM are limited. This study aimed to compare hospitalization and mortality rates of patients identified for CM either by treating primary care physicians (PCPs) or predictive modelling software for hospitalization risk (PM).MethodsIn 2009, a cohort of 6,026 beneficiaries of a German statutory health insurance served as a sample for patient identification for CM by PCPs or commercial PM (CSSG 0.8, Verisk Health). The resulting samples were compared regarding hospitalization and mortality rates in 2010 and in the two year period before patient selection. No CM-intervention was delivered until the end of 2010 and PCPs were blinded for the assessment of hospitalization rates.ResultsIn 2010, hospitalization rates of PM-identified patients were 80% higher compared to PCP-identified patients. Mortality rates were also 8% higher in PM-identified patients if compared to PCP-identified patients (10% vs. 2%). The hospitalization rate of patients independently identified by both PM and PCPs was numerically between PM- and PCP-identified patients. Time trend between 2007 and 2010 showed decreasing hospitalization rates in PM-identified patients (−15% per year) compared to increasing rates in PCP-identified patients (+34% per year).ConclusionsPM identified patients with higher hospitalization and mortality rates compared to PCP-referred patients. But the latter showed increasing hospitalization rates over time thereby suggesting that PCPs may be able to predict future deterioration in patients with relatively good current health status. These patients may most likely benefit from preventive services like CM.

【 授权许可】

CC BY   
© Freund et al.; licensee BioMed Central Ltd. 2013