Medica Research Institute, 401 Carlson Pkwy, Mail Route CW105, Minnetonka, MN 55305. E-mail:
Am J Manag Care. 2017 Jun 1;23(6):e180-e185.
To compare the performance of methods to retrospectively attribute patients to provider systems by comparing the fraction attributed and the stability of assignment over time.
Retrospective cross-sectional study.
Descriptive statistics are used to measure the fraction of patients attributed and stability of attribution from year to year. This study uses a panel of administrative claims data (2010-2011). Attribution rules were defined by unit of measure (count of physician visits, dollars paid), type of providers (primary care physicians [PCPs], all physicians), type of encounters (all visits, evaluation and management visits only), and level of concentration of care (majority, plurality). We created 32 retrospective attribution rules, spanning PCP-only rules, all-physician rules, hierarchical rules based on PCPs then all physicians, and lookback rules based on current-year PCP visits then prior-year experience.
All methods exhibit a tradeoff between stability of attribution and fraction of the population attributed. This tradeoff is minimized when PCP-based rules are supplemented by a 1-year lookback when the current-year experience does not result in attribution.
We recommend using this lookback method when multiple years of data are available. In absence of multiple years of data, PCP-based rules maximize stability; hierarchical rules result in a greater fraction attributed with less loss of stability than simple all-provider rules.
通过比较归因于各提供方系统的患者比例以及随时间推移的分配稳定性，比较回顾性患者分配方法的性能。
回顾性横断面研究。
使用描述性统计来衡量每年归因于患者的比例以及分配的稳定性。本研究使用了一组行政索赔数据（2010-2011 年）。归因规则由度量单位（医生就诊次数、支付金额）、提供者类型（初级保健医生[PCP]、所有医生）、就诊类型（所有就诊、仅评估和管理就诊）和集中护理水平（多数、多数）定义。我们创建了 32 种回顾性归因规则，涵盖 PCP 专用规则、所有医生规则、基于 PCP 然后所有医生的分层规则以及基于当前年度 PCP 就诊然后基于前一年经验的回溯规则。
所有方法都在分配的稳定性和归因患者比例之间存在权衡。当当前年度的经验没有导致分配时，基于 PCP 的规则补充 1 年回溯时，可以将这种权衡最小化。
当有多年数据时，我们建议使用这种回溯方法。在没有多年数据的情况下，基于 PCP 的规则可以最大程度地提高稳定性；分层规则与简单的所有提供者规则相比，归因的比例更高，稳定性损失更小。
