Abstract:
BACKGROUND:There is a growing focus on improving the quality and value of health care delivery for high-cost patients. Compared to fee-for-service Medicare, less is known about the clinical composition of high-cost Medicare Advantage populations. OBJECTIVE:To describe a high-cost Medicare Advantage population and identify clinically and operationally significant subgroups of patients. DESIGN:We used a density-based clustering algorithm to group high-cost patients (top 10% of spending) according to 161 distinct demographic, clinical, and claims-based variables. We then examined rates of utilization, spending, and mortality among subgroups. PARTICIPANTS:Sixty-one thousand five hundred forty-six Medicare Advantage beneficiaries. MAIN MEASURES:Spending, utilization, and mortality. KEY RESULTS:High-cost patients (n = 6154) accounted for 55% of total spending. High-cost patients were more likely to be younger, male, and have higher rates of comorbid illnesses. We identified ten subgroups of high-cost patients: acute exacerbations of chronic disease (mixed); end-stage renal disease (ESRD); recurrent gastrointestinal bleed (GIB); orthopedic trauma (trauma); vascular disease (vascular); surgical infections and other complications (complications); cirrhosis with hepatitis C (liver); ESRD with increased medical and behavioral comorbidity (ESRD+); cancer with high-cost imaging and radiation therapy (oncology); and neurologic disorders (neurologic). The average number of inpatient days ranged from 3.25 (oncology) to 26.09 (trauma). Preventable spending (as a percentage of total spending) ranged from 0.8% (oncology) to 9.5% (complications) and the percentage of spending attributable to prescription medications ranged from 7.9% (trauma and oncology) to 77.0% (liver). The percentage of patients who were persistently high-cost ranged from 11.8% (trauma) to 100.0% (ESRD+). One-year mortality ranged from 0.0% (liver) to 25.8% (ESRD+). CONCLUSIONS:We identified clinically distinct subgroups of patients within a heterogeneous high-cost Medicare Advantage population using cluster analysis. These subgroups, defined by condition-specific profiles and illness trajectories, had markedly different patterns of utilization, spending, and mortality, holding important implications for clinical strategy.
journal_name
J Gen Intern Medjournal_title
Journal of general internal medicineauthors
Powers BW,Yan J,Zhu J,Linn KA,Jain SH,Kowalski JL,Navathe ASdoi
10.1007/s11606-018-4759-1subject
Has Abstractpub_date
2019-02-01 00:00:00pages
218-225issue
2eissn
0884-8734issn
1525-1497pii
10.1007/s11606-018-4759-1journal_volume
34pub_type
杂志文章abstract::Mycophenolate mofetil (MM) is commonly used in patients with autoimmune diseases or who have undergone transplantation. Common side effects of MM include anemia, leukopenia, mucositis and opportunistic infections. We report an unusual case of pulmonary alveolar proteinosis (PAP) in a 67-year-old woman on MM for Wegene...
journal_title:Journal of general internal medicine
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更新日期:2010-10-01 00:00:00
abstract:BACKGROUND:Patients frequently experience suboptimal transitions from the hospital to the community, which can increase the likelihood of readmission. It is not known which care coordination services can lead to improvements in readmission rates. OBJECTIVE:To evaluate the effects of two care coordination interventions...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,多中心研究
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更新日期:2018-05-01 00:00:00
abstract:BACKGROUND:Screening patterns among primary care physicians (PCPs) may be influenced by patient age and comorbidity. Colorectal cancer (CRC) screening has little benefit among patients with limited life expectancy. OBJECTIVE:To characterize the extent to which PCPs modify their recommendations for CRC screening based ...
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doi:10.1007/s11606-012-2093-6
更新日期:2013-01-01 00:00:00
abstract::The Accreditation Council of Graduate Medical Education (ACGME) and the Residency Review Committee require a competency-based, accessible evaluation system. The paper system at our institution did not meet these demands and suffered from low compliance. A diverse committee of internal medicine faculty, program directo...
journal_title:Journal of general internal medicine
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abstract:BACKGROUND:The patient-centered medical home (PCMH) model is being implemented in health centers (HCs) that provide comprehensive primary care to vulnerable populations. OBJECTIVE:To identify characteristics associated with HCs' PCMH capability. DESIGN:Cross-sectional analysis of a national dataset of Federally Quali...
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abstract::We conducted a telephone survey of patients in a university-based medical practice to determine if there was a difference across payer class in patients' willingness to have supervised housestaff physicians function as their primary care providers. Overall, commercial managed care patients were more likely to object t...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1046/j.1525-1497.1998.00100.x
更新日期:1998-05-01 00:00:00
abstract::To describe the determinants of patient satisfaction with medical care, self-administered questionnaires were given to a consecutive sample of 237 patients coming to an ambulatory care practice for the treatment of upper respiratory infections (URIs). Patients' most important goal was to obtain a diagnosis (57%). They...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02599162
更新日期:1992-07-01 00:00:00
abstract:OBJECTIVE:To develop a patient-based classification system to describe the clinical content of ambulatory medicine practices. DESIGN:A system of 100 diagnosis clusters was developed based on retrospective review of computerized problem lists of patients from a university practice, and then applied to the problem lists...
journal_title:Journal of general internal medicine
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abstract:BACKGROUND:Twenty-eight states have passed breast density notification laws, which require physicians to inform women of a finding of dense breasts on mammography. OBJECTIVE:To evaluate changes in breast cancer stage at diagnosis after enactment of breast density notification legislation. DESIGN:Using a difference-in...
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更新日期:2017-06-01 00:00:00
abstract::This Perspective discusses 12 key facts derived from 50 years of health services research and argues that this knowledge base can stimulate innovative thinking about how to make health care systems safer, more efficient, more cost effective, and more patient centered, even as they respond to the needs of diverse commu...
journal_title:Journal of general internal medicine
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更新日期:2015-10-01 00:00:00
abstract:BACKGROUND:Patient navigator (PN) programs can improve breast cancer screening in low income, ethnic/racial minorities. Refugee women have low breast cancer screening rates, but it has not been shown that PN is similarly effective. OBJECTIVE:Evaluate whether a PN program for refugee women decreases disparities in brea...
journal_title:Journal of general internal medicine
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更新日期:2013-11-01 00:00:00
abstract:STUDY OBJECTIVE:To determine the efficacy of a comprehensive, one-month psychosocial training program for first-year medical residents. DESIGN:Nonrandomized, controlled study with immediate pre/post evaluation. Limited evaluation of some residents was also conducted an average of 15 months after teaching. SETTING:Com...
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更新日期:1991-11-01 00:00:00
abstract:BACKGROUND:To practice Evidence-Based Medicine (EBM), physicians must quickly retrieve evidence to inform medical decisions. Internal Medicine (IM) residents receive little formal education in electronic database searching, and have identified poor searching skills as a barrier to practicing EBM. OBJECTIVE:To design a...
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pub_type: 杂志文章,随机对照试验
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更新日期:2007-12-01 00:00:00
abstract:PURPOSE:Studies show that measures of physician and medical students' empathy decline with clinical training. Presently, there are limited data relating self-reported measures to observed behavior. This study explores a self-reported measure and observed empathy in medical students. METHOD:Students in the Class of 200...
journal_title:Journal of general internal medicine
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更新日期:2010-03-01 00:00:00
abstract:OBJECTIVE:Translating lessons from clinical trials on the prevention or delay of type 2 diabetes to populations in nonstudy settings remains a challenge. The purpose of this paper is to review, from the perspective of practicing clinicians, available evidence on lifestyle interventions or medication to prevent or delay...
journal_title:Journal of general internal medicine
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更新日期:2006-01-01 00:00:00
abstract:BACKGROUND:In response to the landmark report "Beyond Bias and Barriers: Fulfilling the Potential of Women in Academic Science and Engineering," the NIH Office of Research on Women's Health issued a request for applications that funded 14 R01 grants to investigate causal factors to career success for women in STEM. Fol...
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pub_type: 杂志文章,评审
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更新日期:2019-03-01 00:00:00
abstract:OBJECTIVE:The purpose of this study is to assess the effect of a geriatrics-focused acute medicine inpatient rotation and the presence or absence of a geriatrician as attending physician on knowledge about and attitudes toward older patients and the field of geriatrics. DESIGN:Randomized trial. INTERVENTION:A 4-week ...
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pub_type: 临床试验,杂志文章,随机对照试验
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更新日期:1996-07-01 00:00:00
abstract:BACKGROUND:Global health measures represent an attractive option for researchers and clinicians seeking a brief snapshot of a patient's overall perspective on his or her health. Because scores on different global health measures are not comparable, comparative effectiveness research (CER) is challenging. OBJECTIVE:To ...
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更新日期:2015-10-01 00:00:00
abstract:BACKGROUND:Obesity and diabetes family history are the two strongest risk factors for type 2 diabetes (T2D). Prior work shows that an individual's obesity risk is associated with obesity in social contacts, but whether T2D risk follows similar patterns is unknown. OBJECTIVE:We aimed to estimate the relationship betwee...
journal_title:Journal of general internal medicine
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更新日期:2016-10-01 00:00:00
abstract:BACKGROUND:As electronic health records (EHRs) become widely adopted, alerts and reminders can improve medication safety, but excessive alerts may irritate or overwhelm clinicians, thereby reducing their effectiveness. We developed a novel "stealth" alert in an EHR to improve anticoagulation monitoring for patients pre...
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更新日期:2012-12-01 00:00:00
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pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
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更新日期:2000-12-01 00:00:00
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journal_title:Journal of general internal medicine
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更新日期:2005-10-01 00:00:00
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更新日期:2020-12-01 00:00:00
abstract:BACKGROUND:National guidelines indicate that healthcare providers should routinely screen women of reproductive age for experience of intimate partner violence. We know little about intimate partner violence (IPV) screening and disclosure experience among women older than reproductive age. OBJECTIVE:To examine the per...
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更新日期:2020-09-01 00:00:00
abstract:OBJECTIVE:To determine whether students who take ambulatory rotations in internal medicine are more likely to choose internal medicine careers. DESIGN:National survey. SETTING AND PARTICIPANTS:The intended sample was 1,650 senior U.S. medical students from 16 medical schools, of whom 1,244 (76%) responded. Representa...
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pub_type: 杂志文章,多中心研究
doi:10.1007/BF02640362
更新日期:1995-10-01 00:00:00
abstract:BACKGROUND:Patient-centered medical home (PCMH) models of primary care have the potential to expand access, improve population health, and lower costs. Federally qualified health centers (FQHCs) were early adopters of PCMH models. OBJECTIVE:We measured PCMH capabilities in a diverse nationwide sample of FQHCs and asse...
journal_title:Journal of general internal medicine
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更新日期:2017-09-01 00:00:00
abstract:BACKGROUND:Referral from primary care to the mental health specialty sector is important but poorly understood. OBJECTIVE:Identify physician characteristics influencing mental health referral. DESIGN:Randomized controlled trial using Standardized Patients (SPs). SETTING:Offices of primary care physicians in 3 cities...
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pub_type: 杂志文章,随机对照试验
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更新日期:2006-06-01 00:00:00
abstract:BACKGROUND:Recent studies that compared patient spending in hospital-owned physician practices versus physician-owned groups did not compare quality of care. Past studies had incomplete measures of physician-hospital integration, or lacked patient-level data. OBJECTIVE:To measure the association between physician-hosp...
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pub_type: 杂志文章
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更新日期:2020-03-01 00:00:00
abstract:OBJECTIVE:To compare physicians' and their patients' attitudes toward pharmaceutical gifts. DESIGN:Survey of physicians and their patients. SETTING:Two tertiary-care medical centers, one military and one civilian. PARTICIPANTS:Two hundred sixty-eight of 392 consecutively surveyed physicians, 100 of 103 randomly sele...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1046/j.1525-1497.1998.00048.x
更新日期:1998-03-01 00:00:00
abstract:OBJECTIVE:To determine the effectiveness and costs of alternative management strategies for patients infected with the human immunodeficiency virus (HIV) who present with pulmonary symptoms. DESIGN:Decision analysis comparing initial testing (arterial blood gas analysis, induced sputum analysis, or bronchoscopy with b...
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doi:10.1007/BF02598081
更新日期:1992-05-01 00:00:00