Intelligent selection of frequent emergency department patients for case management: A machine learning framework based on claims data

References

• Abrams, L. (2013) How much does it cost to go to the ER? The Atlantic. http://www.theatlantic.com/health/archive/2013/02/how-much-does-it-cost-to-go-to-the-er/273599/ (accessed September 2016).
   Google Scholar
• Althaus, F., Paroz, S., and Hugli, O. (2011) Effectiveness of interventions targeting frequent users of emergency departments: a systematic review. Annals of Emergency Medicine, 58(1), 41–52.
   PubMed Web of Science ®Google Scholar
• Anderson, D., and Bjarnadóttir, M. (2016) When is an ounce of prevention worth a pound of cure? Identifying high-risk candidates for case management. IIE Transactions on Healthcare Systems Engineering, 6(1), 22–32.
   Google Scholar
• Billings, J. Background of NYU ED algorithm. http://wagner.nyu.edu/faculty/billings/nyued-background (accessed September 2015).
   Google Scholar
• Blanchard, J. C., Haywood, Y. C., Scott, C. (2003) Racial and ethnic disparities in health: An emergency medicine perspective. Acad Emerg Med, 10(11), 1289–1293.
   Web of Science ®Google Scholar
• Bodenmann, P., Velonaki, V., Ruggeri, O., Hugli, O., Burnand, B., Wasserfallen, J., Moschetti, K., Iglesias, K., Baggio, S., and Daeppen, J. (2014) Case management for frequent users of the emergency department: Study protocol of a randomised controlled trial. BMC Health Services Research, 14(264), 264.
   Google Scholar
• Chan, C. C. (2008) Intelligent value-based customer segmentation method for campaign management: A case study of automobile retailer. Journal Expert Systems with Applications: An international Journal, 34(4), 2754–2762.
   Web of Science ®Google Scholar
• Crane, S., Collins, L., Hall, J., Rochester, D., and Patch, S. (2012) Reducing utilization by uninsured frequent users of the emergency department: Combining case management and drop-in group medical appointments. J Am Board Fam Med, 25, 184–191.
   Web of Science ®Google Scholar
• Dong, G., Taslimitehrani, V. (2016) Pattern aided classification. Proceedings of the 2016 SIAM International Conference on Data Mining, 225–233.
   Google Scholar
• Doran, K. M., Raven, M. C., and Rosenheck, R. A. (2013) What drives frequent emergency department use in an integrated health system? National data from the Veterans Health Administration. Ann Emerg Med, 62(2), 151–159.
   PubMed Web of Science ®Google Scholar
• Doupe, M. B., Palatnick, W., Day, S., Chatau, D., Soodeen, R. A., Burchill, C., and Derksen, S. (2012) Frequent users of emergency departments: Developing standard definitions and defining prominent risk factors. Ann Emerg Med, 60(1), 24–32.
   PubMed Web of Science ®Google Scholar
• Dove, H. G., Duncan, I., and Robb, A. (2003) A prediction model for targeting low-cost, high-risk members of managed care organizations. The American Journal of Managed Care, 9, 381–389.
   PubMed Web of Science ®Google Scholar
• Finkelstein, A. N., Taubman, S. L., Allen, H. L., Wright, B. J., and Baicker, K. (2016) Effect of Medicaid coverage on ED use—Further evidence from Oregon's experiment. N Engl J Med, 375, 1505–1507.
   Web of Science ®Google Scholar
• Fuda, K. K., and Immekus, R. (2006) Frequent users of Massachusetts emergency departments: A statewide analysis. Ann Emerg Med, 48(1), 9–16.
   Web of Science ®Google Scholar
• Gardner, B., Lally, P., and Wardle, J. (2012) Making health habitual: The psychology of “habit-formation” and general practice. The British Journal of General Practice, 62(605), 664–666.
   PubMed Web of Science ®Google Scholar
• Grover, C. A., Close, R.J.H., Villarreal, K., and Goldman, L. M. (2010) Emergency department frequent user: Pilot study of intensive case management to reduce visits and computed tomography. West J Emerg Med, 11(4), 336–343.
   PubMedGoogle Scholar
• Healthcare Cost and Utilization Project (HCUP). (2015a) Clinical Classifications Software (CCS) for ICD-9-CM. Agency for Healthcare Research and Quality, Rockville, MD. https://www.hcup-us.ahrq.gov/toolssoftware/ccs/ccs.jsp (accessed September 2015).
   Google Scholar
• Healthcare Cost and Utilization Project (HCUP). (2015b) Chronic Condition Indicator (CCI) for ICD-9-CM. Agency for Healthcare Research and Quality, Rockville, MD. https://www.hcup-us.ahrq.gov/toolssoftware/chronic/chronic.jsp (accessed September 2015).
   Google Scholar
• Hong, R., Baumann, B. M., Boudreaux, E. D. (2007) The emergency department for routine healthcare: Race/ethnicity, socioeconomic status, and perceptual factors. J Emerg Med, 32(2), 149–158.
   PubMed Web of Science ®Google Scholar
• Hsia, R. Y., and Tabas, J. A. (2009) Emergency care: The increasing weight of increasing waits. Arch Intern Med, 169(20), 1836–1838.
   Google Scholar
• Hunt, K. A., Weber, E. J., Showstack, J. A., Colby, D. C., and Callaham, M. L. (2006) Characteristics of frequent users of emergency departments. Ann Emerg Med, 48(1), 1–8.
   PubMed Web of Science ®Google Scholar
• Johns Hopkins Bloomberg School of Public Health (JH-BSPH). (2015) Primary care visits available to most uninsured but at a high price. http://www.jhsph.edu/news/news-releases/2015/primary-care-visits-available-to-most-uninsured-but-at-a-high-price.html (accessed September 2016).
   Google Scholar
• Komaroff, A. L. (2014) Medicaid expansion in Oregon led to more short-term ED use. NEJM Journal Watch. http://www.jwatch.org/na33444/2014/01/28/medicaid-expansion-oregon-led-more-short-term-ed-use
   Google Scholar
• Kumar, G., and Klein, R. (2013) Effectiveness of case management strategies in reducing emergency department visits in frequent user patient populations: A systematic review. Journal of Emergency Medicine, 44(3), 717–729.
   PubMed Web of Science ®Google Scholar
• LaCalle, E., and Rabin, E. (2010) Frequent users of emergency departments: The myths, the data, and the policy implications. Ann Emerg Med, 56(1), 42–48.
   PubMed Web of Science ®Google Scholar
• Lally, P., and Gardner, B. (2013) Promoting habit formation. Health Psychology Review, 7, 137–158.
   Web of Science ®Google Scholar
• Lambert, D. (1992) Zero-inflated Poisson regression, with an application to defects in manufacturing. Technometrics, 34, 1–14.
   Web of Science ®Google Scholar
• Law, H. Z., Oraka, E., Mannino, D. M. (2011) The role of income in reducing racial and ethnic disparities in emergency room and urgent care center visits for asthma: United States, 2001–2009. J Asthma, 48(4), 405–413.
   PubMed Web of Science ®Google Scholar
• Lee, K. H., and Davenport, L. (2006) Can case management interventions reduce the number of emergency department visits by frequent users? Health Care Manag, 25(2), 155–9.
   Google Scholar
• Lemus, J., Chacko, M., Claudius, L. (2013) Need for intervention in families presenting to the emergency department with multiple children as patients. West J Emerg Med, 14(5), 525–528.
   Google Scholar
• Liu, S. S., Chen, J. (2009) Using data mining to segment healthcare markets from patients' preference perspectives. International Journal of Health Care Quality Assurance, 22(2), 117–134.
   PubMedGoogle Scholar
• Lynn, J., Straube, B. M., Bell, K. M., Jencks, S. F., Kambic, R. T. (2007) Provide better health care for all: The “bridges to health” model. Milbank Quarterly, 85(2), 185–208.
   Web of Science ®Google Scholar
• Mandelberg, J. H., Kuhn, R. E., and Kohn, M. A. (2000). Epidemiologic analysis of an urban, public emergency department's frequent users. Acad Emerg Med, 7, 637–646.
   PubMed Web of Science ®Google Scholar
• Medicaid and CHIP Payment and Access Commission (MACPAC). (2014) Revisiting emergency department use in Medicaid. In MAC facts: Key findings on Medicaid and CHIP. https://www.macpac.gov/wp-content/uploads/2015/01/MACFacts-EDuse_2014-07.pdf (accessed September 2016).
   Google Scholar
• Moore, G., Gerdtz, M., Manias, E., Hepworth, G., and Dent, A. (2007) Socio-demographic and clinical characteristics of re-presentation to an Australian inner-city emergency department: Implications for service delivery. BMC Public Health, 7, 320.
   PubMed Web of Science ®Google Scholar
• Morrison, M., Murphy, T., Nalder, C. (2003) Consumer preferences for general practitioner services. Health Marketing Quarterly, 20(3), 3–19.
   PubMedGoogle Scholar
• Mullahy, J. (1986) Specification and testing of some modified count data models. Journal of Econometrics, 33, 341–365.
   Web of Science ®Google Scholar
• National Center for Health Statistics. (1980) Estimates of selected comparability ratios on dual coding of 1976 death certificates by eighth and ninth revisions of the International Classifications of Diseases. Monthly Vital Statistics Report, 28(11), 1–19.
   Google Scholar
• National Drug Code Directory. (2015) List of FDA approved drugs as of Sept., 2015. https://www.accessdata.fda.gov/scripts/cder/ndc/ (accessed September 2015).
   Google Scholar
• Neufeld, E., Viau, K. A., Hirdes, J. P., and Warry, W. (2016) Predictors of frequent emergency department visits among rural older adults in Ontario using the resident assessment instrument-home care. Aust J Rural Health, 24(2), 115–122.
   Web of Science ®Google Scholar
• Okin, R. L., Boccellari, A., Azocar, F., Shumway, M., O'Brien, K., and Gelb, A. (2000) The effects of clinical case management on hospital service use among ED frequent users. Am J Emerg Med, 18, 603–608.
   PubMed Web of Science ®Google Scholar
• Olson, D. L., and Delen, D. (2008) Advanced Data Mining Techniques, Springer, Berlin, Heidelberg, 138.
   Google Scholar
• Pereira, M., Singh, V., Hon, C. P., McKelvey, T. G., Sushmita, S., and De Cock, M. (2016) Predicting future frequent users of Emergency Departments in California State. Proceeding of the 7th ACM International Conference on Bioinformatics, Computational Biology, and Health Informatics (BCB ‘16), Seattle, WA, USA, 603.610. ACM, New York, NY, USA.
   Google Scholar
• Raven, M., and Gould, D. (2012) Time and again: Frequent users of emergency department services in New York City. United Hospital Fund. https://www.uhfnyc.org/assets/1053 (accessed December 2016).
   Google Scholar
• Shumway, M., Boccellari, A., O'Brien, K., and Okin, R. L. (2008) Cost-effectiveness of clinical case management for ED frequent users: Results of a randomized trial. Am J Emerg Med, 26(2), 155–64.
   PubMed Web of Science ®Google Scholar
• Soril, L.J.J., Leggett, L. E., Lorenzetti, D. L., Noseworthy, T. W., and Clement, F. M. (2015) Reducing frequent visits to the emergency department: A systematic review of interventions. PLoS ONE, 10(4), e0123660.
   PubMed Web of Science ®Google Scholar
• Spillane, L. L., Lumb, E. W., Cobaugh, D. J., Wilcox, S. R., Clark, J. S., and Schneider, S. M. (1997) Frequent users of the emergency department: Can we intervene? Acad Emerg Med, 4, 574–580.
   PubMed Web of Science ®Google Scholar
• Taubman, S. L., Allen, H. L., Wright, B. J., Baicker, K., and Finkelstein, A. N. (2014) Medicaid increases emergency-department use: Evidence from Oregon's health insurance experiment. Science, 343, 263–268.
   PubMed Web of Science ®Google Scholar
• Triandis, H. C. (1977) Interpersonal behavior, Brooks/Cole, Monterey, CA.
   Google Scholar
• U.S. Department of Health and Human Services (HHS). (2017) Who is eligible for Medicaid? https://www.hhs.gov/answers/medicare-and-medicaid/who-is-eligible-for-medicaid/index.html (accessed May 2017).
   Google Scholar
• Vuik, S. I., Mayer, E., Darzil, A. (2016) A quantitative evidence base for population health: Applying utilization-based cluster analysis to segment a patient population. Population Health Metrics, 2016, 14–44.
   Google Scholar
• Weiss, A., Schechter, M., and Chang, G. (2013) Case management for frequent emergency department users. Psychiatric Services, 64(7), 715–716.
   Web of Science ®Google Scholar
• Williams, S. S., Heller, A. (2007) Patient activation among Medicare beneficiaries: Segmentation to promote informed health care decision-making. International Journal of Pharmaceutical and Healthcare Marketing, 1(2), 199–213.
   Google Scholar
• Wu, J., Grannis, S. J., Xu, H., and Finnell, J. T. (2016) A practical method for predicting frequent use of emergency department care using routinely available electronic registration data. BMC Emergency Medicine, 16(1), 1–9.
   Google Scholar