Predicting persistently high primary care use

James M Naessens, Macaran A. Baird, Holly K. Van Houten, David J. Vanness, Claudia R. Campbell

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

PURPOSE: We wanted to identify risk factors for persistently high use of primary care. METHODS: We analyzed outpatient office visits to practitioners in family medicine, general internal medicine, general pediatrics, and obstetrics for 1997-1999 among patients in a small Midwestern city covered by a fee-for-service insurance plan with no co-payments for physician visits and no requirement for referral to specialty care. Logistic regression was used to predict which patients with 10 or more primary care visits in 1997 would repeat high use in 1998 based on demographic and diagnostic categories (adjusted clinical groups [ACGs]). A confirmatory data set (high primary care use in 1998 persistent into 1999) was used to evaluate the model. RESULTS: Two percent of the 54,074 patients had 10 or more primary care visits in 1997, and of these, almost 19% had 10 or more visits in the next year. Among adults, 4 ambulatory diagnosis groups (ADGs) were simultaneously positive predictors of repeated high primary care visits: unstable chronic medical conditions, see and reassure conditions, minor time-limited psychosocial conditions, and minor signs and symptoms. Meanwhile, pregnancy was negatively associated. The area under the receiver operating characteristic (ROC) curve was 0.794 for adults in the developmental data set and 0.752 in the confirmatory data set, indicating a moderately accurate assessment. A satisfactory model was not developed for pediatric patients. CONCLUSIONS: Many persistently high primary care users appear to be overserviced but underserved, with underlying problems not addressed by a medical approach. Some may benefit from psychosocial support, whereas others may be good candidates for disease management interventions.

Original languageEnglish (US)
Pages (from-to)324-330
Number of pages7
JournalAnnals of Family Medicine
Volume3
Issue number4
DOIs
StatePublished - Jul 2005

Fingerprint

Primary Health Care
Pediatrics
Office Visits
Fee-for-Service Plans
Internal Medicine
Disease Management
Insurance
ROC Curve
Obstetrics
Signs and Symptoms
Outpatients
Referral and Consultation
Logistic Models
Medicine
Demography
Physicians
Pregnancy
Datasets

Keywords

  • Ambulatory care diagnosis groups
  • Clinic visits
  • Forecasting
  • Primary health care/utilization

ASJC Scopus subject areas

  • Family Practice

Cite this

Naessens, J. M., Baird, M. A., Van Houten, H. K., Vanness, D. J., & Campbell, C. R. (2005). Predicting persistently high primary care use. Annals of Family Medicine, 3(4), 324-330. https://doi.org/10.1370/afm.352

Predicting persistently high primary care use. / Naessens, James M; Baird, Macaran A.; Van Houten, Holly K.; Vanness, David J.; Campbell, Claudia R.

In: Annals of Family Medicine, Vol. 3, No. 4, 07.2005, p. 324-330.

Research output: Contribution to journalArticle

Naessens, JM, Baird, MA, Van Houten, HK, Vanness, DJ & Campbell, CR 2005, 'Predicting persistently high primary care use', Annals of Family Medicine, vol. 3, no. 4, pp. 324-330. https://doi.org/10.1370/afm.352
Naessens JM, Baird MA, Van Houten HK, Vanness DJ, Campbell CR. Predicting persistently high primary care use. Annals of Family Medicine. 2005 Jul;3(4):324-330. https://doi.org/10.1370/afm.352
Naessens, James M ; Baird, Macaran A. ; Van Houten, Holly K. ; Vanness, David J. ; Campbell, Claudia R. / Predicting persistently high primary care use. In: Annals of Family Medicine. 2005 ; Vol. 3, No. 4. pp. 324-330.
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