Risk adjustment using automated ambulatory pharmacy data - The RxRisk model
Risk adjustment using automated ambulatory pharmacy data - The RxRisk model
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DOI：
10.1097/00005650-200301000-00011
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发表时间：
2003-01-01
期刊：
影响因子：
3
通讯作者：
Rosetti, MCO
中科院分区：
文献类型：
--
作者：
Fishman, PA;Goodman, MJ;Rosetti, MCO
目标.开发和评估RxRisk模型，这是一种风险评估工具，使用自动化门诊药房数据来识别慢性疾病并预测未来的医疗保健成本。将RxRisk模型在预测成本方面的性能与仅人口统计学模型、门诊临床组（ACG）和分层共存条件（HCC）ICD-9-CM基于诊断的风险评估工具进行比较。每个模型的预测医疗资源使用的能力进行了评估。来自美国不同地区的五个混合模式健康维护组织（HMO）的约150万人的健康服务利用率和成本数据。使用自动化管理护理数据的回顾性队列研究。1995年和1996年期间在普吉特海湾团体保健合作社、明尼苏达州和科罗拉多、俄亥俄州和凯撒永久性基金东北地区的保健伙伴登记的所有人。RxRisk是一种将处方药填充分类为成人和儿童慢性疾病类别的算法。HCC比RxRisk或ACG产生最准确的总成本预测，但RxRisk的表现与ACG相似。使用R-2标准，HCC解释了15.4%的成本预期方差，而RxRisk解释了8.7%，ACG解释了10.2%。然而，对于成本分布的关键部分，HCC、RxRisk和ACG之间的预测能力差异不太明显，所有三种模型对中间60%的成本分布产生类似的预测。HCC可以更准确地预测总成本，但基于药房的RxRisk是几种基于诊断的模型的替代风险评估工具，根据应用的性质，可能是医疗风险分析的更合适的选择。
OBJECTIVES. Develop and estimate the RxRisk model, a risk assessment instrument that uses automated ambulatory pharmacy data to identify chronic conditions and predict future health care cost. The RxRisk model's performance in predicting cost is compared with a demographic-only model, the Ambulatory Clinical Groups (ACG), and Hierarchical Coexisting Conditions (HCC) ICD-9-CM diagnosis-based risk assessment instruments. Each model's power to forecast health care resource use is assessed.DATA SOURCES. Health services utilization and cost data for approximately 1.5 million individuals enrolled in five mixed-model Health Maintenance Organizations (HMOs) from different regions in the United States.STUDY DESIGN. Retrospective cohort study using automated managed care data.SUBJECTS. All persons enrolled during 1995 and 1996 in Group Health Cooperative of Puget Sound, Health Partners of Minnesota and the Colorado, Ohio and Northeast Regions of Kaiser-Permanente.MEASURES. RxRisk, an algorithm that classifies prescription drug fills into chronic disease classes for adults and children.RESULTS. HCCs produce the most accurate forecasts of total costs than either RxRisk or ACGs but RxRisk performs similarly to ACGs. Using the R-2 criteria HCCs explain 15.4% of the prospective variance in cost, whereas RxRisk explains 8.7% and ACGs explain 10.2%. However, for key segments of the cost distribution the differences in forecasting power among HCCs, RxRisk, and ACGs are less obvious, with all three models generating similar predictions for the middle 60% of the cost distribution.CONCLUSIONS. HCCs produce more accurate forecasts of total cost, but the pharmacy-based RxRisk is an alternative risk assessment instrument to several diagnostic based models and depending on the nature of the application may be a more appropriate option for medical risk analysis.