Jia Loon Chong1, David Bruce Matchar2,3,4, Yuyang Tan5, Shalini Sri Kumaran5, Mihir Gandhi6,7,8, Marcus Eng Hock Ong1,9, Kok Seng Wong5. 1. Program in Health Services and Systems Research, Duke-NUS Medical School , Singapore, Singapore. 2. Program in Health Services and Systems Research, Duke-NUS Medical School , Singapore, Singapore. david.matchar@duke-nus.edu.sg. 3. Department of Medicine (General Internal Medicine), Duke University Medical Center, Durham, NC, USA. david.matchar@duke-nus.edu.sg. 4. Department of Internal Medicine, Singapore General Hospital, Singapore, Singapore. david.matchar@duke-nus.edu.sg. 5. Department of Internal Medicine, Singapore General Hospital, Singapore, Singapore. 6. Centre for Quantitative Medicine, Duke-NUS Medical School , Singapore, Singapore. 7. Department of Biostatistics, Singapore Clinical Research Institute, Singapore, Singapore. 8. Tampere Center for Child Health Research, Tampere University, Tampere, Finland. 9. Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore.
Abstract
BACKGROUND: As populations age with increasingly complex chronic conditions, segmenting populations into clinically meaningful categories of healthcare and related service needs can provide healthcare planners with crucial information to optimally meet needs. However, while conventional approaches typically involve electronic medical records (EMRs), such records do not always capture information reliably or accurately. OBJECTIVE: We describe the inter-rater reliability and predictive validity of a clinician-administered tool, the Simple Segmentation Tool (SST) for categorizing older individuals into one of six Global Impression (GI) segments and eight complicating factors (CFs) indicative of healthcare and related social needs. DESIGN: Observational study ( ClinicalTrials.gov , number NCT02663037). PARTICIPANTS: Patients aged 55 years and above. MAIN MEASURES: Emergency department (ED) subjects (between May and June 2016) had baseline SST assessment by two physicians and a nurse concurrently seeing the same individual. General medical (GM) ward subjects (February 2017) had a SST assessment by their principal physician. Adverse events (ED visits, hospitalizations, and mortality over 90 days from baseline) were determined by a blinded reviewer. Inter-rater reliability was measured using Cohen's kappa. Predictive validity was evaluated using Cox hazard ratios based on time to first adverse event. KEY RESULTS: Cohen's kappa between physician-physician, service physician-nurse, and physician-nurse pairs for GI were 0.60, 0.71, and 0.68, respectively. Cox analyses demonstrated significant predictive validity of GI and CFs for adverse outcomes. CONCLUSIONS: With modest training, clinicians can complete a brief instrument to segment their patient into clinically meaningful categories of healthcare and related service needs. This approach can complement and overcome current limitations of EMR-based instruments, particularly with respect to whole-patient care. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02663037.
BACKGROUND: As populations age with increasingly complex chronic conditions, segmenting populations into clinically meaningful categories of healthcare and related service needs can provide healthcare planners with crucial information to optimally meet needs. However, while conventional approaches typically involve electronic medical records (EMRs), such records do not always capture information reliably or accurately. OBJECTIVE: We describe the inter-rater reliability and predictive validity of a clinician-administered tool, the Simple Segmentation Tool (SST) for categorizing older individuals into one of six Global Impression (GI) segments and eight complicating factors (CFs) indicative of healthcare and related social needs. DESIGN: Observational study ( ClinicalTrials.gov , number NCT02663037). PARTICIPANTS: Patients aged 55 years and above. MAIN MEASURES: Emergency department (ED) subjects (between May and June 2016) had baseline SST assessment by two physicians and a nurse concurrently seeing the same individual. General medical (GM) ward subjects (February 2017) had a SST assessment by their principal physician. Adverse events (ED visits, hospitalizations, and mortality over 90 days from baseline) were determined by a blinded reviewer. Inter-rater reliability was measured using Cohen's kappa. Predictive validity was evaluated using Cox hazard ratios based on time to first adverse event. KEY RESULTS: Cohen's kappa between physician-physician, service physician-nurse, and physician-nurse pairs for GI were 0.60, 0.71, and 0.68, respectively. Cox analyses demonstrated significant predictive validity of GI and CFs for adverse outcomes. CONCLUSIONS: With modest training, clinicians can complete a brief instrument to segment their patient into clinically meaningful categories of healthcare and related service needs. This approach can complement and overcome current limitations of EMR-based instruments, particularly with respect to whole-patient care. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02663037.
Entities:
Keywords:
aging; health services research; psychometrics
Authors: Lize Duminy; Nirmali Ruth Sivapragasam; David Bruce Matchar; Abhijit Visaria; John Pastor Ansah; Carl Rudolf Blankart; Lukas Schoenenberger Journal: Health Serv Res Date: 2021-12 Impact factor: 3.402