ArticleJournal of general internal medicine2022
Risk Stratification in Primary Care: Value-Based Contributions of Provider Adjudication.
Article in Journal of general internal medicine, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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Who cites it
2 citing papers in PubMed.
- Social determinants of health and hospitalization risk in heart failure: A Retrospective analysis.American heart journal plus : cardiology research and practice · 2026Article
- Multiple sclerosis risk stratification and healthcare cost prediction using machine learning.Communications medicine · 2025Article
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Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundIn primary care risk stratification, automated algorithms do not consider the same factors as providers. The process of adjudication, in which providers review and adjust algorithm-derived risk scores, may improve the prediction of adverse outcomes.
objectiveWe assessed the patient factors that influenced provider adjudication behavior and evaluated the performance of an adjudicated risk model against a commercial algorithm.
design(1) Structured interviews with primary care providers (PCP) and multivariable regression analysis and (2) receiver operating characteristic curves (ROC) with sensitivity analyses.
participantsPrimary care patients aged 18 years and older with an adjudicated risk score. APPROACH AND MAIN MEASURES: (1) Themes from structured interviews and discrete variables associated with provider adjudication behavior; (2) comparison of concordance statistics and sensitivities between risk models. KEY
results47,940 patients were adjudicated by PCPs in 2018. Interviews revealed that, in adjudication, providers consider disease severity, presence of self-management skills, behavioral health, and whether a risk score is actionable. Provider up-scoring from the algorithmic risk score was significantly associated with patient male sex (OR 1.24, CI 1.15-1.34), age > 65 (OR 2.55, CI 2.24-2.91), Black race (1.26, CI 1.02-1.55), polypharmacy >10 medications (OR 4.87, CI 4.27-5.56), a positive depression screen (OR 1.57, CI 1.43-1.72), and hemoglobin A1c >9 (OR 1.89, CI 1.52-2.33). Overall, the adjudicated risk model performed better than the commercial algorithm for all outcomes: ED visits (c-statistic 0.689 vs. 0.684, p < 0.01), hospital admissions (c-statistic 0.663 vs. 0.649, p < 0.01), and death (c-statistic 0.753 vs. 0.721, p < 0.01). When limited to males or seniors, the adjudicated models displayed either improved or non-inferior performance compared to the commercial model.
conclusionsProvider adjudication of risk stratification improves model performance because providers have a personal understanding of their patients and are able to apply their training to clinical decision-making.
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