The 130th Annual Meeting of APHA

Abstract #40730

John J Brusk, MPH, Public Health Program, Nova Southeastern University, 3200 South University Drive, Fort Lauderdale, FL 33328, 954-262-1611, jbrusk@nova.edu and Richard Pozen, MD, iHealth Technolgies, Inc., 6666 Powers Ferry Road, Suite 200, Atlanta, GA 30339.

The objective was to design and implement an information systems method that facilitates healthcare utilization review using automated physician profiling. This proposed method aimed to transcend obstacles such as inability to utilize ambulatory healthcare information for peer-to-peer comparisons of medical service claims. This method demonstrates a solution using a population case mix adjustment process to adjust for potential confounding factors including disease severity, age, gender, and considers random effects which may account for differences due to physician training, practice location or interaction between related providers of care, often located in the same office. The performance of the method presented is tested using a mixed model comprised of these potentially confounding factors. Using this model, a prediction of care required by each patient is calculated A correlation coefficient (R2) is calculated to quantify and evaluate performance. As performance varies with each separate population analyzed, several sample populations were tested. Preliminary results suggest that a large proportion of the sample variation is explained. The caluclated index, referred to as the Case Intensity Mix Index (CIMI), strongly predicts the logarithm of medical resources consumed in several distinct populations. All comparisons of medical services utilized should account for both fixed and random effects associated with various attributes of physician practice. More sophisticated information delivery systems utilizing the CIMI method should be implemented.

Learning Objectives: Participants during this presentation will be able to

• understand the essential role of case mix adjustment method in heath services utilization review,
• identify major case mix adjustment method including their strengths and weaknesses,
• describe a unique and effective new method of case mix adjustment.

Keywords: Health Management Information Systems, Utilization

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: iHealth Technologies, Inc.
I have a significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
Relationship: Consultant for small grant