The goals of this project are to: 1 ) Calculate the prevalence rates for overall and PCS ED use in a managed-care population in central Massachusetts and identify associations between outcomes and patient and practice-level factors;2) Create predictive models using administrative claims data and calculate ED risk scores and evaluate the performance of models predicting overall and PCS ED use;and 3) Expand these models by adding patient characteristics from EMRs, neighborhood characteristics, and practice characteristics. This project will break new ground in predictive modeling of healthcare utilization. No prior studies have published methods for predicting ED use or creating an ED risk score. Our method will include the critical components of risk adjustment necessary for making predictions about future health services use. We also propose the innovation of combining data from linked claims and EMRs with practice and neighborhood characteristics. Our study will determine the predictors of different measures of ED use and create a predictive ED risk score that could be used to identify patients at risk of future ED use. Developing an accurate predictive model/risk score for ED use will enable higher-risk patients (and/or their providers) to be targeted for educational and care management interventions. Additionally, ED prediction models could help in creating performance measures to enable rewarding providers for providing better care and access to care for their patients.

Public Health Relevance

There are no published ED risk score models, which we will create in this study. Creating ED risk score models is important because if providers and payers could accurately evaluate the risk of ED use in a population, they could target high-risk patients with educational and care management programs and try to prevent future ED visits. An ED risk score model could also be used to set credible and fair risk-adjusted targets for expected use for panels of patients against which actual use can be judged.

Agency
National Institute of Health (NIH)
Institute
Agency for Healthcare Research and Quality (AHRQ)
Type
Dissertation Award (R36)
Project #
1R36HS022194-01
Application #
8519793
Study Section
HSR Health Care Research Training SS (HCRT)
Program Officer
Willis, Tamara
Project Start
2013-05-01
Project End
2014-04-30
Budget Start
2013-05-01
Budget End
2014-04-30
Support Year
1
Fiscal Year
2013
Total Cost
Indirect Cost
Name
University of Massachusetts Medical School Worcester
Department
Other Health Professions
Type
Schools of Medicine
DUNS #
603847393
City
Worcester
State
MA
Country
United States
Zip Code
01655