Validation of an algorithm to determine the primary care treatability of emergency department visits

We propose a new claims-computable measure of the primary care treatability of emergency department (ED) visits and validate it using a nationally representative sample of Medicare data. This is a validation study using 2011-2012 Medicare claims data for a nationally representative 5% sample of fee-...

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Bibliographic Details
Published in:BMJ open 2016-08, Vol.6 (8), p.e011739-e011739
Main Authors: Jeffery, Molly Moore, Bellolio, M Fernanda, Wolfson, Julian, Abraham, Jean M, Dowd, Bryan E, Kane, Robert L
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Algorithms
Billings
Comorbidity
Critical care
Decision making
Documentation
Emergency Service, Hospital
Fee-for-Service Plans
Female
Health care access
Health Services Research
Hospital Mortality
Hospitalization
Hospitalization - statistics & numerical data
Humans
Insurance Claim Review
Male
Medicare
Middle Aged
Minnesota
Older people
Patients
Physiology
Population
Primary care
Primary Health Care
Reimbursement
Terminology
Time Factors
United States
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Summary:We propose a new claims-computable measure of the primary care treatability of emergency department (ED) visits and validate it using a nationally representative sample of Medicare data. This is a validation study using 2011-2012 Medicare claims data for a nationally representative 5% sample of fee-for-service beneficiaries to compare the new measure's performance to the Ballard variant of the Billings algorithm in predicting hospitalisation and death following an ED visit. Hospitalisation within 1 day or 1 week of an ED visit; death within 1 week or 1 month of an ED visit. The Minnesota algorithm is a strong predictor of hospitalisations and deaths, with performance similar to or better than the most commonly used existing algorithm to assess the severity of ED visits. The Billings/Ballard algorithm is a better predictor of death within 1 week of an ED visit; this finding is entirely driven by a small number of ED visits where patients appear to have been dead on arrival. The procedure-based approach of the Minnesota algorithm allows researchers to use the clinical judgement of the ED physician, who saw the patient to determine the likely severity of each visit. The Minnesota algorithm may thus provide a useful tool for investigating ED use in Medicare beneficiaries.
ISSN:2044-6055
2044-6055
DOI:10.1136/bmjopen-2016-011739