Christopher L. Vojta|Deneen Vojta|Thomas R. TenHave|Miguel A. Amaya|Risa Lavizzo?Mourey|David A. Asch
Risk screening in a Medicare/Medicaid population
University of Pennsylvania|Center for Clinical Research (United States)|Health Affairs|Institute on Aging|Institute on Aging
compare abilities two validated indices one surveybased databasederived prospectively identify highcost dualeligible medicaremedicaid membersa longitudinal cohort studya medicaid health maintenance organization philadelphia pahmo enrollees n 558 65 years older eligible medicare medicaidtwo hundred ninety six patients responded survey containing probability repeat admission questionnaire pra october november 1998 using readily available administrative data created administrative proxy pra choosing cut point 040 indices maximized sensitivity 55 administrative proxy 50 survey pra classification yielded 103 highrisk patients administrative proxy 73 survey pra highcost patients averaged least 23 times resource utilization 6month followup correlation two scores 053 scales disagreed highcost risk 78 patients 54 highcost administrative proxy 24 highcost survey pra two discordant groups utilized intermediate levels resources 2171 2794 statistically significantly different two groups probability chi2 66 receiver operating characteristic curve areas 068 survey pra administrative proxy respondents 067 administrative proxy nonrespondents revealed similar overall discriminative abilities two instruments coststhe medicaidmedicare dualeligible population responded survey pra rate 53 limiting practical utility screening instrument using cut point 040 administrative proxy performed well survey pra population equally applicable nonrespondents time lag inherent database screening limits applicability new patients combining databasedriven surveybased approaches holds promise targeting patients might benefit case management intervention