Predicting Risk of Hospitalization and Death SD Fihn MD MPH Office - - PowerPoint PPT Presentation

▶
predicting risk of hospitalization and death
SMART_READER_LITE
LIVE PREVIEW

Predicting Risk of Hospitalization and Death SD Fihn MD MPH Office - - PowerPoint PPT Presentation

Dec 28, 2022 367 likes •500 views

Predicting Risk of Hospitalization and Death SD Fihn MD MPH Office of Analytics and Business Intelligence Veterans Health Administration June 2016 Care Assessment Need (CAN) Score Initial CAN developed from data on 4.5M veterans enrolled

slide-1
SLIDE 1

Predicting Risk of Hospitalization and Death

SD Fihn MD MPH Office of Analytics and Business Intelligence Veterans Health Administration

June 2016

slide-2
SLIDE 2

VETERANS HEALTH ADMINISTRATION

Care Assessment Need (CAN) Score

  • Initial CAN developed from data on 4.5M veterans enrolled in

primary care using standard and multinomial (polytomous) logistic regression (Wang L, et al. Med Care 2013;51:368-73)

– ~90 input variables from 7 domains in corporate data warehouse

  • CAN 2.0 deployed in 2016

– Reduced to 36 input variables including composite SES index derived from US CENSUS American Community Survey plus Rank & Service Branch from VA/DOD Identity repository . – Improved concordance (C-statistic) and calibration – Weekly report provides CAN scores & probabilities for 3 outcomes at 90d and 1yr: Mortality, Hospitalization, Mortality or Hospitalization

2

slide-3
SLIDE 3

VETERANS HEALTH ADMINISTRATION

Input Variables

Demographics Utilization Chronic Illness Pharmacy

Age Group Air Force Flag Eligibility (1, [2-4], 5+) Rank Flag (Officer vs Enlisted) Marital Status Priority SES index Sex

Vital Signs

BMI (≥40) Weight Variability HR (80-60) Resp Rate (≥20) Sys & Dias BP

  • No. Hospital/Bed Days
  • No. Medical Providers
  • No. Visit Type:

All Inpatient Emergency Care Cardiology CT Mental Health Other Non-Face Primary Care (PC) Phone Care PC Phone Care

  • No. 11-20min Phone
  • No. 21-30min Phone
  • No. Est Office Visit

Deyo-Charlson Score HCCs: AFib and CHF Dementia Mental Health and PTSD Metastatic Cancer Alcohol Chronic Airway Obstruction

Lab/Radiology

  • No. Albumin
  • No. Blood, Urine, Nitrogen

Lymphocytes (Low) Red Blood Cells (Low) Sodium (Low) White Blood Cells (High)

  • No. Troponin
  • No. Chest X-Ray

Antipsychotic Beta-blocker Benzodiazepine Beta agonist nebulizer Furosemide Statin Metformin NSAID Furosemide Tablets

  • No. of drugs filled

Text Notes

  • No. Consent Notes
  • No. Telephone Notes
slide-4
SLIDE 4

VETERANS HEALTH ADMINISTRATION

Predictive Accuracy

Hospitalization - 1 year 0.81 Hospitalization - 90 day 0.83 Mortality - 1 year 0.85 Mortality - 90 day 0.87 Veterans in highest %ile of risk have 58% probability of admission, 23% probability of death, and 64% probability of either event.

slide-5
SLIDE 5

VETERANS HEALTH ADMINISTRATION

Risk Data Updated Weekly

slide-6
SLIDE 6

VETERANS HEALTH ADMINISTRATION

Use of High Level Analytic Data for Population Management and Resource Planning

1-yr likelihood

  • f admission

1.86% - 5.93% 5.94% - 7.00% 7.01% - 7.97% 7.98% - 9.21% 9.22% - 16.99%

1-yr likelihood of admission or death

2.37% - 9.03% 9.04% - 10.01% 10.02% - 10.96% 10.97% - 12.18% 12.19% - 19.34%

12

Fihn, et al Health Affairs 2014

slide-7
SLIDE 7

VETERANS HEALTH ADMINISTRATION

CAN USAGE 2014 - 2016

7

May underestimate usage because nurse care managers download data for several providers & data can be downloaded directly from regional data warehouses

  • No. of CAN users by month

500 1000 1500 2000 2014 2015 2016

  • 1,000

2,000 3,000 4,000 5,000 6,000 7,000 8,000 2016 2015 2014

  • No. of CAN “hits” by month
slide-8
SLIDE 8

VETERANS HEALTH ADMINISTRATION

Palliative Care Score ≥ 95 --5,000 of 268,833 total patients (1.9%) Hospice Score ≥ 95 -- 775 of 268,833 total patients (0.2%) Few Patients with High Scores Referred to Coordination Programs Telehealth, HBPC, Palliative Care, and Hospice

slide-9
SLIDE 9

VETERANS HEALTH ADMINISTRATION

IRT (Item Response Theory) Analysis of Highest Risk Patients Reveals High Complexity

9

92% 64% 25% 19% 4% 8% 10% 3% 96% 38% 42% 7% 7% 14% 0% 11% 9% 43% 19% 83% 9% 4% 7% 8% 70% 33%

16%

0% 2% 15% 8% 45% 13% 19% 100%

Drug Abuse Depression Anxiety Diabetes Renal Failure CHF Tumor

Complex Mental Health Cardiac Complex Diabetes Cancer Substance Abuse

slide-10
SLIDE 10

VETERANS HEALTH ADMINISTRATION

Patient Care Assessment System (PCAS)

RELEASE 1 (Dec 2013)

  • Panel Overview
  • PACT Team Management
  • Consult Monitoring
  • Demographics & Caregiver Contacts
  • Risk Characteristics (including CAN)

RELEASE 2 (Jun 2015)

  • Tasks & Notifications
  • 6-12 mon. of VA and Non-VA Clinical Data

for all active primary care patients (>5M)

  • One-click Panel Filters for High Risk Sub-Populations

10

Web application to provide Patient Aligned Care Teams (PACT) with tools to identify and coor- dinate care for paneled patients, especially those at highest risk.

slide-11
SLIDE 11

VETERANS HEALTH ADMINISTRATION

PCAS Release 3.0 & Implementation

RELEASE 3.0 (2016)

  • Full Care Planning and Tracking
  • Basic and Dynamic Care Plan Notes
  • Note Integration with CPRS
  • Advanced Panel Queries
  • Clinical Practice Guideline Links

and Clinical Training Resources

IMPLEMENTATION

  • Structured implementation began

with PCAS 2.0

  • 300% increase in utilization since 2.0
  • Users in every VISN (VISN 4 highest) / 1000+ Users

11