Predicting Primary Care Use Among Patients in a Large Integrated Health System
The Role of Patient Experience Measures
Bibliographic Data
| ID | 9098856 |
|---|---|
| Authors | Edwin S Wong (0000-0002-6079-686X, VA Puget Sound Health Care System, corresponding author), Matthew L Maciejewski (0000-0003-1765-5938, Center for Health Services Research in Primary Care, Durham VA Medical Center), Paul L Hebert (0000-0002-5886-7964, VA Puget Sound Health Care System, corresponding author), Ashok Reddy (0000-0001-5238-629X, VA Puget Sound Health Care System, corresponding author), Chuan-Fen Liu (VA Puget Sound Health Care System), Chuan‐Fen Liu (0000-0002-6915-8194, University of Washington, corresponding author) |
| Year | 2019 |
| Volume | 57 |
| Issue | 8 |
| Pages | 608-614 |
| Publication date | 2019-08-01 |
| Open Access | No |
| Type | ARTICLE |
| Venue | Medical Care (JOURNAL) |
| Journal identifiers | ISSN: 0025-7079 • E-ISSN: 1537-1948 |
| Publisher | Ovid Technologies (Wolters Kluwer Health) (PUBLISHER) |
| DOI | 10.1097/mlr.0000000000001155 |
| PMID | 31295190 |
| OpenAlex | W2961228505 |
| Language | EN |
| Citations received | 1 |
| References cited | 28 |
OBJECTIVE: Most Veterans Affairs (VA) Health Care System enrollees age 65+ also have the option of obtaining care through Medicare. Reliance upon VA varies widely and there is a need to optimize its prediction in an era of expanding choice for veterans to obtain care within or outside of VA. We examined whether survey-based patient-reported experiences improved prediction of VA reliance. METHODS: VA and Medicare claims in 2013 were linked to construct VA reliance (proportion of all face-to-face primary care visits), which was dichotomized (=1 if reliance >50%). We predicted reliance in 83,143 Medicare-eligible veterans as a function of 61 baseline characteristics in 2012 from claims and the 2012 Survey of Healthcare Experiences of Patients. We estimated predictive performance using the cross-validated area under the receiver operating characteristic (AUROC) curve, and assessed variable importance using the Shapley value decomposition. RESULTS: In 2012, 68.9% were mostly VA reliant. The AUROC for the model including claims-based predictors was 0.882. Adding patient experience variables increased AUROC to 0.890. The pseudo R for the full model was 0.400. Baseline reliance and patient experiences accounted for 72.0% and 11.1% of the explained variation in reliance. Patient experiences related to the accessibility of outpatient services were among the most influential predictors of reliance. CONCLUSION: The addition of patient experience variables slightly increased predictive performance. Understanding the relative importance of patient experience factors is critical for informing what VA reform efforts should be prioritized following the passage of the 2018 MISSION Act
Actuarial science · Baseline (sea) · Family medicine · Health care · Healthcare system · Patient experience · Primary care · Receiver operating characteristic · Veterans Affairs · Chronic Disease Management Strategies · Medicine · Patient Satisfaction in Healthcare · Primary Care and Health Outcomes
Receiver Operating Characteristic Curve in Diagnostic Test Assessment
Estimators of Relative Importance in Linear Regression Based on Variance Decomposition
Examining the Role of Patient Experience Surveys in Measuring Health Care Quality
Interrater reliability
Decomposition procedures for distributional analysis
A Shapley-based decomposition of the R-Square of a linear regression
Reliance on Veterans Affairs Outpatient Care by Medicare-eligible Veterans
Predicting Resource Utilization in a Veterans Health Administration Primary Care Population
Measures of Adherence to Oral Hypoglycemic Agents at the Primary Care Clinic Level
Iraq and Afghanistan Veterans’ Use of Veterans Health Administration and Purchased Care Before and After Veterans Choice Program Implementation
Veterans’ Access to and Use of Medicare and Veterans Affairs Health Care
| Citations per year | 0.25 |
|---|---|
| Citation span | 2022 - 2022 (1) |
| Highly cited | No |