Characteristics of Adult Primary Care Patients as Predictors of Future Health Services Charges

BACKGROUND: Utilization risk assessment is potentially useful for allocation of health care resources, but precise measurement is difficult. OBJECTIVE: Test the hypotheses that health-related quality of life (HRQOL), severity of illness, and diagnoses at a single primary care visit are comparable case-mix predictors of future 1-year charges in all clinical settings within a large health system, and that these predictors are more accurate in combination than alone. RESEARCH DESIGN: Longitudinal observational study in which subjects' characteristics were measured at baseline, and their outpatient clinic visits and charges and their inpatient hospital days and charges were tracked for 1 year. SUBJECTS: Adult primary care patients. MEASURES: Duke Health Profile for HRQOL, Duke Severity of Illness Checklist for severity of illness, and Johns Hopkins Ambulatory Care Groups for diagnostic groups classification. RESULTS: Of 1, 202 patients, 84. 4% had follow up in the primary care clinic, 63. 2% in subspecialty clinics, 14. 8% in the emergency room, and 9. 6% in the hospital. Of 6, 290, 775 total charges, 779, 037 (12. 2%) was for follow-up primary care. The highest accuracy was found for predicting primary care charges, where R2 for predictors ranged from 0. 083 for medical record auditor-reported severity of illness to 0. 107 for HRQOL. When predictors were combined, the highest R2 of 0. 125 was found for the combination of HRQOL and diagnostic groups. CONCLUSIONS: Baseline HRQOL, severity of illness, and diagnoses were comparable predictors of 1-year health services charges in all clinical sites but most predictive for primary care charges, and were more accurate in combination than alone.