Presentation Details
| Ambulatory Procedure Complications Change based on Patient Co-morbidities captured by AM-PPC Monitoring. Ajay Perumbeti M.D., Dana Casey RHIA, Dickson Okozogbon M.D., Sandeep Wadhwa M.D.. Solventum, Health Information Systems, Clinical & Economic Research, St.Paul, MN, USA |
Abstract
BACKGROUND: Procedures are shifting to ambulatory settings with procedural advancements, patient preferences, and financial incentives. Solventum Ambulatory Potentially Preventable Complications v1.3 prototype (AM-PPC) is a risk adjusted clinical categorical model for benchmarking 30 day complications rates for same day procedures. AM-PPC risk adjustment employs a specialized version of Solventum Clinical Risk Group (CRG) grouper for clinically coherent comorbidity classification (CC) for fair severity adjustment. We explored complication patterns impacted by comorbidity.
PURPOSE: Analysis was done with Solventum AM-PPC v1.3 prototype and CMS Medicare FFS facility claims for CY 2021-2023. AM-PPC clinically groups procedures (n=116 groups) and 30-day complications (n=70 groups). Comorbidity classification spans CC0: healthy and minor chronic disease, CC1: moderate and dominant chronic disease, CC2: two dominant chronic diseases, and CC3: multi-morbidity and frailty based on coded secondary diagnoses. We analysed top 3 complications across PSG based on CC. Jaccard Similarity Index ( J(A,B)=(∣A∩B∣∣A∪B∣ ), was calculated to evaluate CC overlap across PSG. Analysis tools were Python v3.7.9 with Visual Studio Code v1.96.3 and Microsoft Excel v2411.
RESULTS: Complication rates were CC0: 1.5%, CC1: 2.5%, CC2: 3.6%, and CC3: 6%. An average of 7-8 unique top 3 Complication Groups (range: 3-12) existed across CC for PSGs. Fifty-four percent of PSGs shared top complication across all CC levels. Jaccard similarity (JS) of CC0->CC1 (0.67) and CC1->CC2 (0.73) was moderate. JS showed more churn in CC2-> CC3 (0.59). Greatest impact of comorbidities was with shock (64.5% PSG), acute pulmonary edema/respiratory failure (62.2% PSG), and acute post hemorrhagic anemia with transfusion (58.2% PSG). Spark lines were informative of PSG specific Complication Group patterns as shown by cardiac catheterization examples. (Figure 1)
CONCLUSIONS: Comorbidities impact complication rates and groups. There is benefit for precision monitoring of ambulatory complications to include comorbidity risk adjustment to monitor the right complication prevention, target reduced complication rates, and reduce total cost of care.
No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.
PURPOSE: Analysis was done with Solventum AM-PPC v1.3 prototype and CMS Medicare FFS facility claims for CY 2021-2023. AM-PPC clinically groups procedures (n=116 groups) and 30-day complications (n=70 groups). Comorbidity classification spans CC0: healthy and minor chronic disease, CC1: moderate and dominant chronic disease, CC2: two dominant chronic diseases, and CC3: multi-morbidity and frailty based on coded secondary diagnoses. We analysed top 3 complications across PSG based on CC. Jaccard Similarity Index ( J(A,B)=(∣A∩B∣∣A∪B∣ ), was calculated to evaluate CC overlap across PSG. Analysis tools were Python v3.7.9 with Visual Studio Code v1.96.3 and Microsoft Excel v2411.
RESULTS: Complication rates were CC0: 1.5%, CC1: 2.5%, CC2: 3.6%, and CC3: 6%. An average of 7-8 unique top 3 Complication Groups (range: 3-12) existed across CC for PSGs. Fifty-four percent of PSGs shared top complication across all CC levels. Jaccard similarity (JS) of CC0->CC1 (0.67) and CC1->CC2 (0.73) was moderate. JS showed more churn in CC2-> CC3 (0.59). Greatest impact of comorbidities was with shock (64.5% PSG), acute pulmonary edema/respiratory failure (62.2% PSG), and acute post hemorrhagic anemia with transfusion (58.2% PSG). Spark lines were informative of PSG specific Complication Group patterns as shown by cardiac catheterization examples. (Figure 1)
CONCLUSIONS: Comorbidities impact complication rates and groups. There is benefit for precision monitoring of ambulatory complications to include comorbidity risk adjustment to monitor the right complication prevention, target reduced complication rates, and reduce total cost of care.
No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.
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