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High-Cost Patients: Hot-Spotters Don’t Explain the Half of It

Overview of attention for article published in JGIM: Journal of General Internal Medicine, August 2016
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  • Above-average Attention Score compared to outputs of the same age (53rd percentile)
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Mentioned by

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3 tweeters

Citations

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18 Dimensions

Readers on

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64 Mendeley
Title
High-Cost Patients: Hot-Spotters Don’t Explain the Half of It
Published in
JGIM: Journal of General Internal Medicine, August 2016
DOI 10.1007/s11606-016-3790-3
Pubmed ID
Authors

Natalie S. Lee, Noah Whitman, Nirav Vakharia, Glen B. Taksler PhD, Michael B. Rothberg

Abstract

Understanding resource utilization patterns among high-cost patients may inform cost reduction strategies. To identify patterns of high-cost healthcare utilization and associated clinical diagnoses and to quantify the significance of hot-spotters among high-cost users. Retrospective analysis of high-cost patients in 2012 using data from electronic medical records, internal cost accounting, and the Centers for Medicare and Medicaid Services. K-medoids cluster analysis was performed on utilization measures of the highest-cost decile of patients. Clusters were compared using clinical diagnoses. We defined "hot-spotters" as those in the highest-cost decile with ≥4 hospitalizations or ED visits during the study period. A total of 14,855 Medicare Fee-for-service beneficiaries identified by the Medicare Quality Resource and Use Report as having received 100 % of inpatient care and ≥90 % of primary care services at Cleveland Clinic Health System (CCHS) in Northeast Ohio. The highest-cost decile was selected from this population. Healthcare utilization and diagnoses. The highest-cost decile of patients (n = 1486) accounted for 60 % of total costs. We identified five patient clusters: "Ambulatory," with 0 admissions; "Surgical," with a median of 2 surgeries; "Critically Ill," with a median of 4 ICU days; "Frequent Care," with a median of 2 admissions, 3 ED visits, and 29 outpatient visits; and "Mixed Utilization," with 1 median admission and 1 ED visit. Cancer diagnoses were prevalent in the Ambulatory group, care complications in the Surgical group, cardiac diseases in the Critically Ill group, and psychiatric disorders in the Frequent Care group. Most hot-spotters (55 %) were in the "frequent care" cluster. Overall, hot-spotters represented 9 % of the high-cost population and accounted for 19 % of their overall costs. High-cost patients are heterogeneous; most are not so-called "hot-spotters" with frequent admissions. Effective interventions to reduce costs will require a more multi-faceted approach to the high-cost population.

Twitter Demographics

The data shown below were collected from the profiles of 3 tweeters who shared this research output. Click here to find out more about how the information was compiled.

Mendeley readers

The data shown below were compiled from readership statistics for 64 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Unknown 64 100%

Demographic breakdown

Readers by professional status Count As %
Researcher 14 22%
Student > Master 12 19%
Unspecified 9 14%
Other 7 11%
Student > Bachelor 5 8%
Other 17 27%
Readers by discipline Count As %
Medicine and Dentistry 23 36%
Unspecified 15 23%
Nursing and Health Professions 7 11%
Psychology 6 9%
Business, Management and Accounting 2 3%
Other 11 17%

Attention Score in Context

This research output has an Altmetric Attention Score of 2. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 07 September 2016.
All research outputs
#6,945,468
of 12,348,320 outputs
Outputs from JGIM: Journal of General Internal Medicine
#2,816
of 4,308 outputs
Outputs of similar age
#118,760
of 267,167 outputs
Outputs of similar age from JGIM: Journal of General Internal Medicine
#66
of 135 outputs
Altmetric has tracked 12,348,320 research outputs across all sources so far. This one is in the 42nd percentile – i.e., 42% of other outputs scored the same or lower than it.
So far Altmetric has tracked 4,308 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 14.5. This one is in the 33rd percentile – i.e., 33% of its peers scored the same or lower than it.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 267,167 tracked outputs that were published within six weeks on either side of this one in any source. This one has gotten more attention than average, scoring higher than 53% of its contemporaries.
We're also able to compare this research output to 135 others from the same source and published within six weeks on either side of this one. This one has gotten more attention than average, scoring higher than 50% of its contemporaries.