Do Hierarchical Condition Category Model Scores Predict Hospitalization Risk in Newly Enrolled Medicare Advantage Participants as Well as Probability of Repeated Admission Scores?

Mosley, David G.; Peterson, Eileen; Martin, David C.

doi:10.1111/j.1532-5415.2009.02558.x

Cited by 21 publications

(17 citation statements)

References 14 publications

(45 reference statements)

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“…Nonetheless, the following strata were statistically signifi cant: low risk (PRA<0.30), medium risk (PRA=0.30-0.49) and high risk (PRA≥0.500). 1,11,19 The observed predictive accuracy of the area under the ROC curve was 0. In our study, the PRA showed improved ability to identify elderly at risk of hospitalization within six months, when a cutoff value of 0.4 was used to defi ne the high risk population.…”

Section: Discussionmentioning

confidence: 99%

Validade preditiva de instrumento para identificação do idoso em risco de hospitalização

Dutra

Moriguchi

Lampert³

et al. 2011

Rev. Saúde Pública

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OBJETIVO: Avaliar a validade de predição do Instrumento de Predição de Risco de Admissão Hospitalar Repetida da hospitalização de idosos. MÉTODOS: Estudo de coorte de base populacional com seguimento de seis meses com 515 idosos (> 60 anos de idade) não-institucionalizados, atendidos pela Estratégia Saúde da Família na cidade de Progresso, RS, em 2005. Os idosos responderam a oito perguntas objetivas, que foram reunidas em modelo de regressão logística para estimar seu risco de admissão hospitalar futura, por estratos de risco. Análise de sobrevida e a curva Receiver Operating Characteristics foram empregadas para aferir a validade do instrumento. RESULTADOS: Dos entrevistados, 56,1% eram mulheres e 10,1% foram hospitalizados. O grupo de risco alto teve freqüência de internação hospitalar 6,5 vezes superior em relação ao grupo de risco baixo. CONCLUSÕES: O instrumento é efetivo ao predizer o risco de hospitalização dos idosos atendidos pela Estratégia Saúde da Família do Sistema Único de Saúde.

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Section: Discussionmentioning

confidence: 99%

Validade preditiva de instrumento para identificação do idoso em risco de hospitalização

Dutra

Moriguchi

Lampert³

et al. 2011

Rev. Saúde Pública

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“…Most risk stratification models stress comorbid illness, like Medicare’s hierarchical condition codes 6. Investigators have attempted to look at other factors, eg, psychosocial factors, to help predict high health care utilization 7.…”

Section: Introductionmentioning

confidence: 99%

Association between underweight and hospitalization, emergency room visits, and mortality among patients in community medical homes

Takahashi

Sauver²,

Olson

et al. 2013

RMHP

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BackgroundIn older adults, underweight (body mass index [BMI] <18.5) has been associated with increased mortality. This increased mortality risk may be associated with increased health care utilization. We evaluated the relationship between underweight and hospitalization, emergency room visits, and mortality.MethodsAn analysis of a retrospective cohort study was conducted at a multisite academic primary care medical practice in Minnesota. The patients were ≥60 years of age, impaneled within primary care on January 1, 2011, and had a BMI measurement recorded between January 1, 2011, and December 31, 2011. Individuals were excluded if they refused review of their medical record. The primary measurement was BMI, which was categorized as underweight (BMI < 18.5) or normal and obese (BMI ≥ 18.5). The outcomes were hospitalization, emergency room visits, and mortality in the 2011 calendar year. Associations between underweight and each outcome were calculated using logistic regression. Interactions between underweight and gender were assessed in the logistic regression models. The final results were adjusted for age, gender, comorbid health conditions, and single living status.ResultsThe final cohort included 21,019 patients, of whom 220 (1%) were underweight. Underweight patients had a higher likelihood of hospitalization compared with patients with higher BMI (adjusted odds ratio [OR] 1.64; 95% confidence interval [CI] 1.21–2.22). Underweight patients were also more likely to visit the emergency room (adjusted OR 1.70; 95% CI 1.28–2.25) or to die (adjusted OR 3.64; 95% CI 2.33–5.69). Men with a BMI < 18.5 compared with those having a BMI ≥ 18.5 had the highest odds of hospitalization (OR 3.45; 95% CI 1.59–7.48).ConclusionUnderweight older adults, especially men, have higher odds of hospitalization, emergency room visits, and mortality. Future work on underweight might involve improving weight status, which may reduce the risk of hospitalization, emergency room visits, and mortality.

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“…The major diagnoses and the comorbidity count were defined using the Hierarchical Condition Category (HCC) model, which provides a disease-specific, validated methodology for risk stratification (18). We used the CMS CY 2011 HCC Risk Adjustment Model to create 184 “Condition Category” variables (19).…”

Section: Design and Methodsmentioning

confidence: 99%

Metformin Use in Practice: Compliance With Guidelines for Patients With Diabetes and Preserved Renal Function

et al. 2017

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IN BRIEF Several contraindications limit the use of metformin, most notably the risk of lactic acidosis. This article reports on an examination of a population of patients with diabetes with preserved renal function to evaluate provider compliance with guidelines on metformin use and to identify factors that contributed when practice diverged from recommendations. It found that metformin was withheld from approximately one-third of these patients because of 1) an existent contraindication to metformin, 2) patient behavior or preference, or 3) provider preference or bias based on patient or personal factors. Although providers generally follow current recommendations for the use of metformin, deviations from guidelines in practice are common.

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Do Hierarchical Condition Category Model Scores Predict Hospitalization Risk in Newly Enrolled Medicare Advantage Participants as Well as Probability of Repeated Admission Scores?

Abstract: HCC scores provided to MA plans for risk adjustment of revenue can also be used to identify hospitalization risk. Additional studies are required to evaluate whether a hybrid approach incorporating administrative and self-reported models would further optimize risk stratification efforts.

Cited by 21 publications

References 14 publications

Validade preditiva de instrumento para identificação do idoso em risco de hospitalização

Validade preditiva de instrumento para identificação do idoso em risco de hospitalização

Association between underweight and hospitalization, emergency room visits, and mortality among patients in community medical homes

Metformin Use in Practice: Compliance With Guidelines for Patients With Diabetes and Preserved Renal Function

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