Clinical trial NCT03327896: The Impact of Patient Complexity on Healthcare Utilization
Official title: The Impact of Patient Complexity on Healthcare Utilization
Study type: OBSERVATIONAL
Overall status: UNKNOWN
Conditions: Primary Care Quality Metrics
Well Child Visits in First 15 Months of Life NQF 1392
Diabetes Mellitus NQF 0059
Colorectal Cancer Screening NQF 0034
Emergency Department Utilization
Alcohol and Drug Screening
Keywords: Quality Measures, Social Determinants of Health
Lead sponsor: OCHIN, Inc.
Sponsor class: OTHER
Collaborators: name: University of Florida
First posted: 2017-11-01
Enrollment: 200000
Sex: ALL
Standard ages: CHILD
ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Observational model: CASE_ONLY
Time perspective: RETROSPECTIVE
Sampling method: NON_PROBABILITY_SAMPLE
Study population: Stage 1 (Patient Level): Established patients of primary care providers with a visit in 2015 Stage 2 (Provider level): Primary Care providers with at least 20 patients from established patients in 2015 Stage 3 (Clinic level): Primary care Clinics

Brief summary: Healthcare providers are routinely being assessed for metrics designed to assess the quality of the care they deliver. There is growing consensus that these measurements, which typically assess the percentage of patients meeting a specific standard of care, should be adjusted for the clinical complexity of the providers. This study will assess whether adjusting for the social complexity of the patient panel adds significantly to adjustment for clinical complexity in explaining apparent differences in quality of care provided by Primary care providers and clinics.

Detailed description: The analysis will be conducted in 2 stages. In the first stage, indicators of social complexity (as assessed by characteristics of the patients' geocoded addresses) will be tested for significant association with patient level outcomes (meeting or not meeting a specific standard of care). These indicators will be assessed in 4 cohorts: 2 cohorts of patients identified in electronic health records of Clinical Research Networks of community health centers, and 2 cohorts of patients insured by Medicaid in 2015 (Oregon and Florida Medicaid cohorts). Due to limitations in the available data, some quality indicators can only be evaluated in a subset of the cohorts. The consistency of specific social complexity indicators, referred to as Community Vital Signs (CVS), will be evaluated across the cohorts and quality metrics.

In the second stage, CVS indicators that contributed consistently to models at the patient level will be evaluated for their effect on provider ranking on quality metrics if the metrics are adjusted for the social complexity of the providers' patient panel in addition to the panels' clinical complexity.

Eligibility criteria: Inclusion criteria for clinics: Clinics must be a clinic that offers Primary Care (Family Medicine Clinics, Pediatrics Clinics, General Practice Clinics, Internal Medicine clinics that are not limited to a subspecialty focus, and multi-specialty clinics that include primary care providers as part of a comprehensive care team.) Clinics must have implemented their EHR by 1/1/2014.

Inclusion criteria for patients: EHR Patients must be established patients within a health care system: at least one ambulatory visit to an included clinic in 2015 and at least 1 visit to a primary care clinic within the same health system prior to that visit.

Inclusion criteria for patients for Medicaid based Outcomes: Patient must have been continuously covered by Medicaid in 2015 and have had at least 1 visit billed as an office visit in 2015 with a provider identified as a primary care provider and at least 1 prior claim billed to the same provider. Patients must meet the age/condition criteria for the assessment of at least 1 secondary outcome.

Exclusion Criteria:

Exclusion criteria for patients: Patients with no geocoded address on file will be excluded from the analysis.

Exclusion criteria for patients for Medicaid based Outcomes: Patient with Medicaid coverage gaps of \>45 days will be excluded from theses analyses. Exclusion criteria for providers: Providers with \<20 patients in any Quality metric denominator.

Primary outcomes:
measure: Provider Ranking as Assessed by Health Care Quality Metrics
timeFrame: 1 year (2015)
Secondary outcomes:
measure: Well Child Visits in first 15 Months of life (patient level)
timeFrame: 15 months
measure: Screening for alcohol and drug misuse (patient level)
timeFrame: 1 year (2015)
measure: Emergency Department Visits (Patient level)
timeFrame: 1 year (2015)
measure: Avoidable Emergency Department Visits (Patient level)
timeFrame: 1 year (2015)
measure: Uncontrolled Hemoglobin A1c in Diabetics (patient level)
timeFrame: 1 year
measure: Colorectal Cancer Screening (Patient level)
timeFrame: 1 year
Other outcomes:
Locations:
Study officials:
affiliation: OCHIN, Inc.
name: Abigail Sears, MBA
role: PRINCIPAL_INVESTIGATOR
References:
citation: Hughes LS, Phillips RL Jr, DeVoe JE, Bazemore AW. Community Vital Signs: Taking the Pulse of the Community While Caring for Patients. J Am Board Fam Med. 2016 May-Jun;29(3):419-22. doi: 10.3122/jabfm.2016.03.150172.