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Clinical Outcome and Utilization Profiles Among Latent Groups of High-Risk Patients: Moving from Segmentation Towards Intervention.

Publication ,  Journal Article
Hutchins, F; Thorpe, J; Maciejewski, ML; Zhao, X; Daniels, K; Zhang, H; Zulman, DM; Fihn, S; Vijan, S; Rosland, A-M
Published in: J Gen Intern Med
August 2022

BACKGROUND: The ability of latent class models to identify clinically distinct groups among high-risk patients has been demonstrated, but it is unclear how healthcare data can inform group-specific intervention design. OBJECTIVE: Examine how utilization patterns across latent groups of high-risk patients provide actionable information to guide group-specific intervention design. DESIGN: Cohort study using data from 2012 to 2015. PATIENTS: Participants were 934,787 patients receiving primary care in the Veterans Health Administration, with predicted probability of 12-month hospitalization in the top 10th percentile during 2014. MAIN MEASURES: Patients were assigned to latent groups via mixture-item response theory models based on 28 chronic conditions. We modeled odds of all-cause mortality, hospitalizations, and 30-day re-hospitalizations by group membership. Detailed outpatient and inpatient utilization patterns were compared between groups. KEY RESULTS: A total of 764,257 (81.8%) of patients were matched with a comorbidity group. Groups were characterized by substance use disorders (14.0% of patients assigned), cardiometabolic conditions (25.7%), mental health conditions (17.6%), pain/arthritis (19.1%), cancer (15.3%), and liver disease (8.3%). One-year mortality ranged from 2.7% in the Mental Health group to 14.9% in the Cancer group, compared to 8.5% overall. In adjusted models, group assignment predicted significantly different odds of each outcome. Groups differed in their utilization of multiple types of care. For example, patients in the Pain group had the highest utilization of in-person primary care, with a mean (SD) of 5.3 (5.0) visits in the year of follow-up, while the Substance Use Disorder group had the lowest, with 3.9 (4.1) visits. The Substance Use Disorder group also had the highest rates of using services for housing instability (25.1%), followed by the Liver group (10.1%). CONCLUSIONS: Latent groups of high-risk patients had distinct hospitalization and utilization profiles, despite having comparable levels of predicted baseline risk. Utilization profiles pointed towards system-specific care needs that could inform tailored interventions.

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Published In

J Gen Intern Med

DOI

EISSN

1525-1497

Publication Date

August 2022

Volume

37

Issue

10

Start / End Page

2429 / 2437

Location

United States

Related Subject Headings

  • Substance-Related Disorders
  • Pain
  • Inpatients
  • Humans
  • Hospitalization
  • General & Internal Medicine
  • Cohort Studies
  • 4206 Public health
  • 4203 Health services and systems
  • 3202 Clinical sciences
 

Citation

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MLA
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Hutchins, F., Thorpe, J., Maciejewski, M. L., Zhao, X., Daniels, K., Zhang, H., … Rosland, A.-M. (2022). Clinical Outcome and Utilization Profiles Among Latent Groups of High-Risk Patients: Moving from Segmentation Towards Intervention. J Gen Intern Med, 37(10), 2429–2437. https://doi.org/10.1007/s11606-021-07166-w
Hutchins, Franya, Joshua Thorpe, Matthew L. Maciejewski, Xinhua Zhao, Karin Daniels, Hongwei Zhang, Donna M. Zulman, Stephan Fihn, Sandeep Vijan, and Ann-Marie Rosland. “Clinical Outcome and Utilization Profiles Among Latent Groups of High-Risk Patients: Moving from Segmentation Towards Intervention.J Gen Intern Med 37, no. 10 (August 2022): 2429–37. https://doi.org/10.1007/s11606-021-07166-w.
Hutchins F, Thorpe J, Maciejewski ML, Zhao X, Daniels K, Zhang H, et al. Clinical Outcome and Utilization Profiles Among Latent Groups of High-Risk Patients: Moving from Segmentation Towards Intervention. J Gen Intern Med. 2022 Aug;37(10):2429–37.
Hutchins, Franya, et al. “Clinical Outcome and Utilization Profiles Among Latent Groups of High-Risk Patients: Moving from Segmentation Towards Intervention.J Gen Intern Med, vol. 37, no. 10, Aug. 2022, pp. 2429–37. Pubmed, doi:10.1007/s11606-021-07166-w.
Hutchins F, Thorpe J, Maciejewski ML, Zhao X, Daniels K, Zhang H, Zulman DM, Fihn S, Vijan S, Rosland A-M. Clinical Outcome and Utilization Profiles Among Latent Groups of High-Risk Patients: Moving from Segmentation Towards Intervention. J Gen Intern Med. 2022 Aug;37(10):2429–2437.
Journal cover image

Published In

J Gen Intern Med

DOI

EISSN

1525-1497

Publication Date

August 2022

Volume

37

Issue

10

Start / End Page

2429 / 2437

Location

United States

Related Subject Headings

  • Substance-Related Disorders
  • Pain
  • Inpatients
  • Humans
  • Hospitalization
  • General & Internal Medicine
  • Cohort Studies
  • 4206 Public health
  • 4203 Health services and systems
  • 3202 Clinical sciences