Association Between Physician Risk Assessment, Hierarchical Condition Categories, and Utilization of Medical Services
Association Between Physician Risk Assessment, Hierarchical Condition Categories, and Utilization of Medical Services
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DOI：
10.1089/pop.2019.0236
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发表时间：
2020-05-18
影响因子：
2.5
通讯作者：
Judge, Stephen R.
中科院分区：
文献类型：
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作者：
Fortuna, Robert J.;Clark, John S.;Judge, Stephen R.
病情分级 (HCC) 是一种常见的风险调整工具，可以支持护理管理资源与人群的临床需求保持一致。作者研究了 HCC 评分与医生确定的临床风险 (CR) 评分、年费和医疗护理利用之间的关联。 CR 评分被定义为未来一年内“急诊室或入院”的预期风险。对于 HCC 总评分确定的前 50 名高危患者中的每一位，患者的初级保健医生 (PCP) 根据他们的判断输入 CR 评分。共有 128 位 PCP 对纽约手指湖地区 31 个初级保健机构的 6167 名各个年龄段的患者进行了评分。 HCC 评分与医师 CR 评分之间的多重相关性为 44.0%（P < 0.001）；只有 18.5% 的 PCP 相关性 >60%。 CR 评分与费用之间呈正相关（斜率 19.7K；P < 0.001），HCC 评分与费用之间呈正相关（斜率 25.7K；P < 0.001）。 HCC 和 CR 评分均与内科/外科入院、急诊科 (ED) 就诊和先进影像的使用呈正相关 (P < 0.001)。在广泛的患者中，HCC 评分与医生确定的 CR 评分（患者急诊室就诊或入院风险）之间存在中度至弱相关性。 CR 评分和 HCC 评分均与费用和利用率呈正相关。 HCC 可能有助于卫生资源的分配，但与医生确定的 CR 评分的相关性相对较弱，值得谨慎对待。
Hierarchical Condition Categories (HCCs) are a common risk adjustment tool that may support alignment of care management resources with the clinical needs of a population. The authors examined the association between HCC scores and physician-determined clinical risk (CR) scores, annual charges, and utilization of medical care. CR score was defined as the anticipated risk for "ED or a hospital admission" within the following year. For each of the top 50 high-risk patients identified by total HCC score, the patient's primary care physician (PCP) entered a CR score based on their judgement. A total of 128 PCPs entered scores on 6167 patients of all ages across 31 primary care practices in the Finger Lakes Region of New York. Multiple correlation between HCC scores and physician CR scores was 44.0% (P < 0.001); only 18.5% of PCPs had a correlation >60%. There was a positive association between CR score and charges (slope 19.7K; P < 0.001) and between HCC score and charges (slope 25.7K; P < 0.001). Both HCC and CR scores were positively correlated (P < 0.001) with medical/surgical admissions, emergency department (ED) visits, and utilization of advanced imaging. Across a broad range of patients, HCC scores had a moderate-to-weak correlation with physician-determined CR scores for patients' risk of an ED visit or hospital admission. Both CR scores and HCCs scores were positively associated with charges and utilization. HCCs may assist in the allocation of health resources, but the relatively weak correlation with physician-determined CR scores warrants caution.