TY - JOUR
T1 - Assessing the Added Value of Vital Signs Extracted from Electronic Health Records in Healthcare Risk Adjustment Models
AU - Kitchen, Christopher
AU - Chang, Hsien Yen
AU - Weiner, Jonathan P.
AU - Kharrazi, Hadi
N1 - Funding Information:
This work was made possible by previous database management, support, and conceptualization from the team at the Center for Population Health IT (CPHIT). This manuscript also references the Adjusted Clinical Groups (ACG) system, which is supported by CPHIT and its collaborators at Johns Hopkins HealthCare Solutions.
Publisher Copyright:
© 2022 Kitchen et al..
PY - 2022
Y1 - 2022
N2 - Purpose: Patient vital signs are related to specific health risks and outcomes but are underutilized in the prediction of health-care utilization and cost. To measure the added value of electronic health record (EHR) extracted Body Mass Index (BMI) and blood pressure (BP) values in improving healthcare risk and utilization predictions. Patients and Methods: A sample of 12,820 adult outpatients from the Johns Hopkins Health System (JHHS) were identified between 2016 and 2017, having high data quality and recorded values for BMI and BP. We evaluated the added value of BMI and BP in predicting health-care utilization and cost through a retrospective cohort design. BMI, mean arterial pressure (MAP), systolic and diastolic BPs were summarized as annual aggregated values. Concurrent annual BMI and MAP changes were quantified as the difference between maximum and minimum recorded values. Model performance estimates consisted of repeated 10-fold cross validation, compared to base model point estimates for demographic and diagnostic, coded events: (1) patient age and sex, (2) age, sex, and the Charlson weighted index, (3) age, sex and the Johns Hopkins ACG system’s DxPM risk score. Results: Both categorical BMI and BP were progressively indicative of disease comorbidity, but not uniformly related to health-care utilization or cost. Annual change in BMI and MAP improved predictions for most concurrent year outcomes when compared to base models. Conclusion: When a healthcare system lacks relevant diagnostic or risk assessment information for a patient, vital signs may be useful for a simple estimation of disease risk, cost and utilization.
AB - Purpose: Patient vital signs are related to specific health risks and outcomes but are underutilized in the prediction of health-care utilization and cost. To measure the added value of electronic health record (EHR) extracted Body Mass Index (BMI) and blood pressure (BP) values in improving healthcare risk and utilization predictions. Patients and Methods: A sample of 12,820 adult outpatients from the Johns Hopkins Health System (JHHS) were identified between 2016 and 2017, having high data quality and recorded values for BMI and BP. We evaluated the added value of BMI and BP in predicting health-care utilization and cost through a retrospective cohort design. BMI, mean arterial pressure (MAP), systolic and diastolic BPs were summarized as annual aggregated values. Concurrent annual BMI and MAP changes were quantified as the difference between maximum and minimum recorded values. Model performance estimates consisted of repeated 10-fold cross validation, compared to base model point estimates for demographic and diagnostic, coded events: (1) patient age and sex, (2) age, sex, and the Charlson weighted index, (3) age, sex and the Johns Hopkins ACG system’s DxPM risk score. Results: Both categorical BMI and BP were progressively indicative of disease comorbidity, but not uniformly related to health-care utilization or cost. Annual change in BMI and MAP improved predictions for most concurrent year outcomes when compared to base models. Conclusion: When a healthcare system lacks relevant diagnostic or risk assessment information for a patient, vital signs may be useful for a simple estimation of disease risk, cost and utilization.
KW - health care costs
KW - health care organizations and systems
KW - information technology in health
KW - technology assessment
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U2 - 10.2147/RMHP.S356080
DO - 10.2147/RMHP.S356080
M3 - Article
C2 - 36092549
AN - SCOPUS:85137372185
SN - 1179-1594
VL - 15
SP - 1671
EP - 1682
JO - Risk Management and Healthcare Policy
JF - Risk Management and Healthcare Policy
ER -