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

Parkerson, George R. Jr., MD, MPH*; Harrell, Frank E. Jr., PhD; Hammond, William E. PhD*; Wang, Xin-Qun MS

Original Articles

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.

*From the Department of Community and Family Medicine, Duke University Medical Center, Durham, North Carolina.

†From the Division of Biostatistics and Epidemiology, Department of Health Evaluation Sciences, University of Virginia School of Medicine.

Funding was provided by the Agency for Healthcare Research and Quality (AHRQ grant HS09821-02) and the Department of Community and Family Medicine, Duke University Medical Center.

Address correspondence and reprint requests to: Dr. Parkerson, Department of Community and Family Medicine, Duke University Medical Center, Box 3886, Durham, NC 27710. E-mail:

Received November 28, 2000; initial review January 26, 2001; accepted June 13, 2001.

© 2001 Lippincott Williams & Wilkins, Inc.