Blumenthal Karen J, Chang Yuchiao, Ferris Timothy G, Spirt Jenna C, Vogeli Christine, Wagle Neil, Metlay Joshua P
Division of General Internal Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
Population Health Management, Partners HealthCare, Boston, MA, USA.
J Gen Intern Med. 2017 Aug;32(8):877-882. doi: 10.1007/s11606-017-4041-y. Epub 2017 Mar 24.
Research studies have shown that patient-reported outcome measures (PROMs) that assess global health are helpful for predicting health care utilization, but less evidence exists that collection of PROMs in routine care can identify patients with high health care needs.
To investigate the association between the PROMIS Global Health (PGH) scores and subsequent health care utilization among patients in a large accountable care organization (ACO).
Retrospective cohort study of individuals in the Partners HealthCare ACO who completed at least one PGH during a primary care visit.
A total of 2639 individuals who completed at least one PGH and who also had 12 months of ACO membership and/or claims data prior to the PROM completion and at least one month of claims data post-PGH completion.
The main outcomes were the rates of emergency department (ED) visits and hospitalizations by quartile of PGH physical and mental health scores. We also compared the predictive accuracy of administrative data models with and without the PGH scores to identify the highest utilizers.
The group with the worst (lowest) physical and mental health scores had significantly higher rates of hospitalization (RR 5.14, 95% CI 2.37, 11.15; and 2.27, 95% CI 1.06, 4.85, respectively) than those with higher scores. After adjustment for demographic and clinical factors, only the group with lower physical health scores had higher rates of hospitalization (RR 3.15, 95% CI 1.30, 7.90). The addition of the physical health subscore to administrative data increased the sensitivity to detect the top 5% of hospital utilizers compared with administrative data alone (44.0% vs. 36.0% respectively).
Worse self-reported physical health, measured during routine primary care, is associated with significantly higher rates of hospitalization. It is not associated with increased rates of ED visits. Self-reported physical health modestly increases the sensitivity to detect the highest hospital utilizers.
研究表明，评估整体健康状况的患者报告结局指标（PROMs）有助于预测医疗保健的使用情况，但在常规护理中收集PROMs能否识别出有高医疗需求的患者，相关证据较少。
调查大型责任医疗组织（ACO）中患者的PROMIS全球健康（PGH）评分与随后的医疗保健使用情况之间的关联。
对在初级保健就诊期间完成至少一次PGH的合作伙伴医疗保健ACO中的个体进行回顾性队列研究。
共有2639名个体完成了至少一次PGH，并且在完成PROM之前有12个月的ACO会员资格和/或索赔数据，在完成PGH之后有至少1个月的索赔数据。
主要结局是按PGH身心健康评分四分位数划分的急诊科就诊率和住院率。我们还比较了有和没有PGH评分的管理数据模型的预测准确性，以识别最高使用量者。
身心健康评分最差（最低）的组的住院率（分别为RR 5.14，95%CI 2.37，11.15；和2.27，95%CI 1.06，4.85）显著高于评分较高的组。在调整人口统计学和临床因素后，只有身体健康评分较低的组住院率较高（RR 3.15，95%CI 1.30，7.90）。与仅使用管理数据相比，将身体健康子评分添加到管理数据中可提高检测前5%住院高使用量者的敏感性（分别为44.0%对36.0%）。
在常规初级保健期间自我报告的较差身体健康状况与显著更高的住院率相关。它与急诊科就诊率增加无关。自我报告的身体健康状况适度提高了检测最高住院使用量者的敏感性。
