University of Michigan, 1500 E Medical Center Dr, 3912 Taubman Center, Ann Arbor, MI 48105. Email:
Am J Manag Care. 2023 Mar 1;29(3):e71-e78. doi: 10.37765/ajmc.2023.89332.
Patients with complex chronic conditions have varying multidisciplinary care needs and utilization patterns, which limit the effectiveness of initiatives designed to improve continuity of care (COC) and reduce utilization. Our objective was to categorize patients with complex chronic conditions into distinct groups by pattern of outpatient care use and COC to tailor interventions.
Observational cohort study from 2014 to 2015.
We identified patients whose 1-year hospitalization risk was in at least the 90th percentile in 2014 who had a chronic gastrointestinal disease (cirrhosis, inflammatory bowel disease, chronic pancreatitis) as case examples of complex chronic disease. We described frequency of office visits, number of outpatient providers, and 2 COC measures (usual provider of care, Bice-Boxerman COC indices) over 12 months. We used latent profile analysis, a statistical method for identifying distinct subgroups, to categorize patients based on overall, primary care, gastroenterology, and mental health continuity patterns.
The 26,751 veterans in the cohort had a mean (SD) of 13.3 (8.6) office visits and 7.2 (3.8) providers in 2014. Patients were classified into 5 subgroups: (1) high gastroenterology-specific COC with mental health use; (2) high gastroenterology-specific COC without mental health use; (3) high overall utilization with mental health use; (4) low overall COC with mental health use; and (5) low overall COC without mental health use. These groups varied in their sociodemographic characteristics and risk for hospitalization, emergency department use, and mortality.
Patients at high risk for health care utilization with specialty care needs can be grouped by varying propensity for health care continuity patterns.
患有复杂慢性病的患者具有不同的多学科护理需求和利用模式，这限制了旨在提高连续性护理（COC）和减少利用的举措的有效性。我们的目标是通过门诊护理使用和 COC 模式将患有复杂慢性病的患者分为不同的组别，以便进行针对性的干预。
2014 年至 2015 年的观察性队列研究。
我们确定了在 2014 年住院风险至少处于第 90 百分位的患有慢性胃肠疾病（肝硬化、炎症性肠病、慢性胰腺炎）的患者作为复杂慢性疾病的病例示例。我们描述了在 12 个月内的就诊频率、门诊提供者数量和 2 项 COC 指标（常规医疗提供者、Bice-Boxerman COC 指数）。我们使用潜在剖面分析，这是一种用于识别不同亚组的统计方法，根据整体、初级保健、胃肠病学和心理健康连续性模式对患者进行分类。
队列中的 26751 名退伍军人在 2014 年的平均（标准差）就诊次数为 13.3（8.6）次，就诊提供者为 7.2（3.8）人。患者分为 5 个亚组：（1）高胃肠病学特异性 COC 伴心理健康使用；（2）高胃肠病学特异性 COC 无心理健康使用；（3）高整体利用率伴心理健康使用；（4）低整体 COC 伴心理健康使用；和（5）低整体 COC 无心理健康使用。这些组在社会人口统计学特征和住院、急诊室使用和死亡率方面存在差异。
具有专科护理需求和高医疗保健利用率风险的患者可以根据其医疗保健连续性模式的不同倾向进行分组。
