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Defining Complex Patient Populations: Implications for Population Size, Composition, Utilization, and Costs.

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Identifying patients with complex needs significantly impacts care programs. Different selection criteria yield vastly different patient groups, highlighting the need for careful consideration in program design.

Keywords:
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Area of Science:

  • Health Services Research
  • Population Health Management
  • Healthcare Informatics

Background:

  • Interventions for patients with complex needs are increasing, yet methods for identifying these patients are underdeveloped.
  • The selection criteria for complex care interventions significantly influence patient cohort characteristics, with limited understanding of these implications.

Purpose of the Study:

  • To analyze the impact of different patient selection criteria on complex care interventions.
  • To compare the characteristics of patient cohorts identified using various definitions of complex needs within a large health plan.

Main Methods:

  • Retrospective observational descriptive study of over 4 million members of Kaiser Permanente Southern California.
  • Implementation and comparison of 25 different definitions for five archetypes of complex needs: high-cost, multiple chronic conditions, frail elders, and high-utilizers of emergency departments and inpatient services.
  • Analysis of demographic characteristics, chronic conditions, healthcare utilization, spending, and survival across identified patient cohorts.

Main Results:

  • 32.7% of the adult population met at least one definition of complex needs.
  • The number of patients identified as complex varied dramatically, from 1583 to 622,560, depending on the criteria used.
  • Identified complex patient cohorts exhibited significant variations in demographics, health status, healthcare use, costs, and survival outcomes.

Conclusions:

  • The selection of patient criteria is a critical determinant in designing effective complex care programs.
  • Exploratory analysis of patient selection criteria is essential for informed program planning, especially with limited resources.
  • Generating data on population criteria should be a foundational step in designing complex care interventions.