Using a Self-Reported Global Health Measure to Identify Patients at High Risk for Future Healthcare Utilization

Blumenthal, Karen; Chang, Yuchiao; Ferris, Timothy G.; Spirt, Jenna; Vogeli, Christine; Wagle, Neil W.; Metlay, Joshua P.

doi:10.1007/s11606-017-4041-y

Cited by 38 publications

(34 citation statements)

References 25 publications

(32 reference statements)

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“…We found higher ED use (not hospitalizations) among rural versus urban residents, which has been reported by other Canadian studies (53,55) and attributed to access barriers or a perceived need for specialized services (56, 57) as well as the tendency of rural physicians to practice in EDs and hospitals and thus encourage patients to use these services (58,59). Our study found that low/poor self-perceived health and functionality were linked to higher acute care service use, consistent with other studies (60)(61)(62)(63) and research showing that adding functional status to administrative-based chronic illness data improves the ability to identify high risk/high-cost system users (60,64). We found that lower perceived self-reported mental health was associated with lower hospital use (not ED use), unlike studies that show that mental health disorders are a key driver of higher ED use (65) (66).…”

Section: Comparison With Existing Literaturesupporting

confidence: 93%

Effect of socio-demographic and health factors on the association between multimorbidity and acute care service use: population-based survey linked to health administrative data

Fisher

Griffith

Gruneir

et al. 2020

Preprint

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Background: This study explores how socio-demographic and health factors shape the relationship between multimorbidity and one-year acute care service use (i.e., hospital, emergency department visits) in older adults in Ontario, Canada.Methods: We linked multiple cycles (2005-2006, 2007-2008, 2009-2010, 2011-2012) of the Canadian Community Health Survey (CCHS) to health administrative data to create a cohort of adults aged 65 and older. Administrative data were used to estimate one-year service use and to identify 12 chronic conditions used to measure multimorbidity. We examined the relationship between multimorbidity and service use stratified by a range of socio-demographic and health variables available from the CCHS. Logistic and Poisson regressions were used to explore the association between multimorbidity and service use and the role of socio-demographic factors in this relationship.Results: Of the 28,361 members of the study sample, 60% were between the ages of 65 and 74 years, 57% were female, 72% were non-immigrant, and over 75% lived in an urban area. Emergency department visits and hospitalizations consistently increased with the level of multimorbidity. This study did not find strong evidence of moderator or interaction effects across a range of socio-demographic factors. Stratified analyses revealed further patterns, with many being similar for both services – e.g., the odds ratios were higher at all levels of multimorbidity for men, older age groups, and those with lower household income. Rurality and immigrant status influenced emergency department use (higher in rural residents and non-immigrants) but not hospitalizations. Multimorbidity and the range of socio-demographic variables remained significant predictors of service use in the regressions.Conclusions: Strong evidence links multimorbidity with increased acute care service use. This study showed that a range of factors did not modify this relationship. Nevertheless, the factors were independently associated with acute care service use, pointing to modifiable risk factors that can be the focus of resource allocation and intervention design to reduce service in those with multimorbidity. The study’s results suggest that optimizing acute care service use in older adults requires attention to both multimorbidity and social determinants, with programs that are multifactorial and integrated across the health and social service sectors.

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Section: Comparison With Existing Literaturesupporting

confidence: 93%

Effect of socio-demographic and health factors on the association between multimorbidity and acute care service use: population-based survey linked to health administrative data

Fisher

Griffith

Gruneir

et al. 2020

Preprint

View full text Add to dashboard Cite

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“…Self-perceived physical health and daily functioning (IADLs in our study) were each associated with acute care service use in the adjusted analysis, with low/poor self-perceived health and functionality linked to higher ED use and hospitalizations. Previous research is consistent with our nding (69)(70)(71)(72), and also shows that adding functional status to health status measures derived from administrative data improves the ability to identify high risk/high-cost system users (69,73). Studies also show that, compared to users of primary care services and medical clinics, more people will seek ED services for health problems causing pain, limitations in their daily functioning, and risk of complications (57,62,74).…”

Section: Comparison With Existing Literaturesupporting

confidence: 83%

“…Evidence exists linking lower self-perceived mental health to higher use of mental health services, complementary services (e.g., chiropractic, acupuncture), and general practice (75); however, the evidence is weaker in relation to use of hospitalizations. Remes et al (76) found that anxiety was not associated with hospital admissions unless it was comorbid with depression, and other studies show that self-reported mental health was not as strong in predicting hospitalizations as various physical health measures (e.g., self-reported physical health, physical comorbidity) (69,77). Regarding ED use, U.S. studies suggest that mental health disorders are a key driver of ED use, regardless of insurance coverage.…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

Effect of socio-demographic factors on the association between multimorbidity and acute care service use: a population-based retrospective cohort study

Fisher

Griffith

Gruneir

et al. 2020

Preprint

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Abstract Background: This study explores how a broad-range of socio-demographic factors shape the relationship between multimorbidity and one-year acute care service use (i.e., hospital, emergency department visits) among older adults in Ontario, Canada. Methods: We linked multiple cycles (2005-2006, 2007-2008, 2009-2010, 2011-2012) of the Canadian Community Health Survey (CCHS) to health administrative data to create a cohort of adults aged 65 and older in Ontario. Twelve chronic conditions identified from the administrative data were used to estimate multimorbidity (number of chronic conditions). We identified acute care service use over one year from the administrative data. We examined the relationship between multimorbidity and service use stratified by a comprehensive range of socio-demographic variables available from the CCHS. Logistic and Poisson multivariable regressions were used to explore the association between multimorbidity and service use and the role of socio-demographic factors in shaping this relationship. Results: Of the 28,361 members of the study sample, 60% were between the ages of 65 and 74 years, 57% were female, 72% were non-immigrant, and over 75% lived in an urban area. Emergency department visits and hospitalizations consistently increased with the level of multimorbidity. Stratified analyses revealed further patterns, with many being similar for both services – e.g., the odds ratios for both services were higher at all levels of multimorbidity for men, older age groups, and those with lower annual household income. Rurality and immigrant status appeared to impact emergency department use (higher in rural residents and non-immigrants) but not hospitalizations. Multimorbidity and most socio-demographic variables remained significant predictors of acute care service use in the multivariable regressions. Conclusions: Strong evidence links multimorbidity with increased acute care service use. This study showed that socio-demographic factors did not modify the relationship between multimorbidity and acute care service use, they were independently associated with acute care service use. Acute care service use was associated with perceived physical and mental health status as well as psychosocial factors, suggesting that optimizing service use requires attention to self-reported health status and social determinants, with programs that are multifaceted and integrated across the health and social service sectors.

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“…The PROMIS10 combines items evaluating physical health, pain, fatigue, mental health, social health, and general health to provide a snapshot of global health through physical and mental health summary scores that are normalized to the general population (6). As a publicly available survey, the PROMIS10 is increasingly being implemented throughout health care systems as a "bottom line" indicator of health status and to meet the reporting requirements of value-based health care initiatives (7)(8)(9)(10). Given the growing use of the PROMIS10 as a default measure of patient-reported health status, understanding its performance characteristics, including responsiveness or sensitivity to change in specific diseases, would support its use as a valid tool for monitoring patient-centered outcomes in different clinical contexts.…”

Section: Introductionmentioning

confidence: 99%

Responsiveness of the Patient‐Reported Outcomes Measurement Information System Global Health Short Form in Outpatients With Systemic Lupus Erythematosus

Kasturi

Szymonifka

Berman

et al. 2020

Arthritis Care & Research

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Objective To evaluate the longitudinal responsiveness (sensitivity to change) of the Patient‐Reported Outcomes Measurement Information System (PROMIS) Global Health Short Form (PROMIS10) in outpatients with systemic lupus erythematosus (SLE). Methods Outpatients with SLE who were receiving care at an academic medical center completed the PROMIS10 at 2 visits that were a minimum of 1 month apart. Responsiveness of the PROMIS10 global physical and mental health domains to Patient‐Reported improvement or deterioration of health status was evaluated, as measured by standard validated instruments. Effect sizes of changes in PROMIS10 scores between visits were evaluated using Kruskal‐Wallis testing. Results A total of 223 SLE patients enrolled and completed baseline surveys, with 186 (83.4%) completing a second set of questionnaires. The PROMIS10 demonstrated mild‐to‐moderate responsiveness to Patient‐Reported improvement (effect size 0.29) and worsening (effect sizes –0.27 and –0.54) of health status for both global physical health and global mental health. Changes in the PROMIS10 correlated poorly with changes in physician‐reported measures of disease activity. Conclusion The PROMIS10 showed responsiveness over time to Patient‐Reported changes in SLE health status, but not physician‐assessed changes. These data suggest that the PROMIS10 can be used to efficiently measure and monitor important aspects of the SLE patient experience that are not captured by standard physician‐derived metrics. Further studies are needed to evaluate the role of the PROMIS10 in optimizing longitudinal disease management in SLE and to determine its responsiveness in other chronic health conditions.

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Using a Self-Reported Global Health Measure to Identify Patients at High Risk for Future Healthcare Utilization

Cited by 38 publications

References 25 publications

Effect of socio-demographic and health factors on the association between multimorbidity and acute care service use: population-based survey linked to health administrative data

Effect of socio-demographic and health factors on the association between multimorbidity and acute care service use: population-based survey linked to health administrative data

Effect of socio-demographic factors on the association between multimorbidity and acute care service use: a population-based retrospective cohort study

Responsiveness of the Patient‐Reported Outcomes Measurement Information System Global Health Short Form in Outpatients With Systemic Lupus Erythematosus

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