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Common Risk Stratification of Hospital and Ambulatory Patients

Cowen, Mark E.; Walsh, Martha M.; Posa, Patricia J.; Leeman, Lauren R.; Van Hoek, Elizabeth; Czerwinski, Jennifer L.

The Journal for Healthcare Quality (JHQ): May 22, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/JHQ.0000000000000203
Original Article: PDF Only

ABSTRACT The care of patients with multiple chronic conditions and those near the end-of-life is often compromised by miscommunications among the healthcare teams. These might be improved by using common risk strata for both hospital and ambulatory settings. We developed, validated, and implemented an all-payer ambulatory risk stratification based on the patients' predicted probability of dying within 30 days, for a large multispecialty practice. Strata had comparable 30-day mortality rates to hospital strata already in use. The high-risk ambulatory strata contained less than 20% of the ambulatory population yet captured 85% of those with 3 or more comorbidities, more than 80% of those who would die 30 or 180 days from the date of scoring, and two-thirds of those with a nonsurgical hospitalization within the next 30 days. We provide examples how the practice and partner hospital have begun to use this common framework for their clinical care model.

For more information on this article, contact Mark E. Cowen at


P. J. Posa has received consulting fees from the Michigan Health and Hospital Association, and the American Hospital Association. The remaining authors declare no conflicts of interest.

This article has not been submitted previously to this journal, nor has it been presented previously outside of internal or informal external meetings, or been published previously. The work meets applicable ethical standards. All authors take public responsibility for the work and satisfy the requirements of authorship.

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© 2019 National Association for Healthcare Quality
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