Data from: Validation of the What Matters Index: a brief, patient-reported index that guides care for chronic conditions and can substitute for computer-generated risk models

Introduction: Current health care delivery relies on complex,
computer-generated risk models constructed from insurance claims and
medical record data. However, these models produce inaccurate predictions
of risk levels for individual patients, do not explicitly guide care, and
undermine health management investments in many patients at lesser risk.
Therefore, this study prospectively validates a concise patient-reported
risk assessment that addresses these inadequacies of computer-generated
risk models. Methods: Five measures with well-documented impacts on the
use of health services are summed to create a "What Matters
Index." These measures are: 1) insufficient confidence to self-manage
health problems, 2) pain, 3) bothersome emotions, 4) polypharmacy, and 5)
adverse medication effects. We compare the sensitivity and predictive
values of this index with two representative risk models in a population
of 8619 Medicaid recipients. Results: The patient-reported "What
Matters Index" and the conventional risk models are found to exhibit
similar sensitivities and predictive values for subsequent hospital or
emergency room use. Furthermore, the "What Matters Index" is
also reliable: akin to its performance during development, for patients
with index scores of 1, 2, and ≥3, the odds ratios (with 95% confidence
intervals) for subsequent hospitalization within 1 year, relative to
patients with a score of 0, are 1.3 (1.1-1.6), 2.0 (1.6-2.4), and 3.4
(2.9-4.0), respectively; for emergency room use, the corresponding odds
ratios are 1.3 (1.1-1.4), 1.9 (1.6-2.1), and 2.9 (2.6-3.3). Similar
findings were replicated among smaller populations of 1061 mostly older
patients from nine private practices and 4428 Medicaid patients without
chronic conditions. Summary: In contrast to complex computer-generated
risk models, the brief patient-reported "What Matters Index"
immediately and unambiguously identifies fundamental, remediable needs for
each patient and more sensibly directs the delivery of services to patient
categories based on their risk for subsequent costly care.