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Prediction Models for Future High-Need High-Cost Healthcare Use: a Systematic Review.

التفاصيل البيبلوغرافية
العنوان: Prediction Models for Future High-Need High-Cost Healthcare Use: a Systematic Review.
المؤلفون: de Ruijter UW; Section of Medical Decision Making, Department of Public Health, Erasmus MC, University Medical Center, Dr. Molewaterplein 40, 3015, GD, Rotterdam, The Netherlands.; Department of Internal Medicine, Northwest Clinics, Alkmaar, The Netherlands., Kaplan ZLR; Section of Medical Decision Making, Department of Public Health, Erasmus MC, University Medical Center, Dr. Molewaterplein 40, 3015, GD, Rotterdam, The Netherlands. z.kaplan@erasmusmc.nl., Bramer WM; Medical Library, Erasmus MC, University Medical Center, Rotterdam, The Netherlands., Eijkenaar F; Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands., Nieboer D; Section of Medical Decision Making, Department of Public Health, Erasmus MC, University Medical Center, Dr. Molewaterplein 40, 3015, GD, Rotterdam, The Netherlands., van der Heide A; Section of Care at the End of Life, Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, The Netherlands., Lingsma HF; Section of Medical Decision Making, Department of Public Health, Erasmus MC, University Medical Center, Dr. Molewaterplein 40, 3015, GD, Rotterdam, The Netherlands., Bax WA; Department of Internal Medicine, Northwest Clinics, Alkmaar, The Netherlands.
المصدر: Journal of general internal medicine [J Gen Intern Med] 2022 May; Vol. 37 (7), pp. 1763-1770. Date of Electronic Publication: 2022 Jan 11.
نوع المنشور: Systematic Review
اللغة: English
بيانات الدورية: Publisher: Springer Country of Publication: United States NLM ID: 8605834 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1525-1497 (Electronic) Linking ISSN: 08848734 NLM ISO Abbreviation: J Gen Intern Med Subsets: MEDLINE
أسماء مطبوعة: Publication: Secaucus, NJ : Springer
Original Publication: [Philadelphia, PA] : Hanley & Belfus, [c1986-
مواضيع طبية MeSH: Delivery of Health Care* , Health Services Needs and Demand*, Adult ; Bias ; Cost-Benefit Analysis ; Humans ; Models, Theoretical ; Prognosis ; Risk Assessment
مستخلص: Background: In an effort to improve both quality of care and cost-effectiveness, various care-management programmes have been developed for high-need high-cost (HNHC) patients. Early identification of patients at risk of becoming HNHC (i.e. case finding) is crucial to a programme's success. We aim to systematically identify prediction models predicting future HNHC healthcare use in adults, to describe their predictive performance and to assess their applicability.
Methods: Ovid MEDLINE® All, EMBASE, CINAHL, Web of Science and Google Scholar were systematically searched from inception through January 31, 2021. Risk of bias and methodological quality assessment was performed through the Prediction model Risk Of Bias Assessment Tool (PROBAST).
Results: Of 5890 studies, 60 studies met inclusion criteria. Within these studies, 313 unique models were presented using a median development cohort size of 20,248 patients (IQR 5601-174,242). Predictors were derived from a combination of data sources, most often claims data (n = 37; 62%) and patient survey data (n = 29; 48%). Most studies (n = 36; 60%) estimated patients' risk to become part of some top percentage of the cost distribution (top-1-20%) within a mean time horizon of 16 months (range 12-60). Five studies (8%) predicted HNHC persistence over multiple years. Model validation was performed in 45 studies (76%). Model performance in terms of both calibration and discrimination was reported in 14 studies (23%). Overall risk of bias was rated as 'high' in 40 studies (67%), mostly due to a 'high' risk of bias in the subdomain 'Analysis' (n = 37; 62%).
Discussion: This is the first systematic review (PROSPERO CRD42020164734) of non-proprietary prognostic models predicting HNHC healthcare use. Meta-analysis was not possible due to heterogeneity. Most identified models estimated a patient's risk to incur high healthcare expenditure during the subsequent year. However, case-finding strategies for HNHC care-management programmes are best informed by a model predicting HNHC persistence. Therefore, future studies should not only focus on validating and extending existing models, but also concentrate on clinical usefulness.
(© 2022. The Author(s).)
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فهرسة مساهمة: Keywords: health expenditures; managed care programmes; meaningful use; patient care management; prognosis
تواريخ الأحداث: Date Created: 20220112 Date Completed: 20220526 Latest Revision: 20220808
رمز التحديث: 20240628
مُعرف محوري في PubMed: PMC9130365
DOI: 10.1007/s11606-021-07333-z
PMID: 35018571
قاعدة البيانات: MEDLINE
الوصف
تدمد:1525-1497
DOI:10.1007/s11606-021-07333-z