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Capturing complexity in clinician case-mix: classification system development using GP and physician associate data.

Halter, M; Joly, L; de Lusignan, S; Grant, RL; Gage, H; Drennan, VM (2018) Capturing complexity in clinician case-mix: classification system development using GP and physician associate data. BJGP Open, 2 (1). bjgpopen18X101277. ISSN 2398-3795 https://doi.org/10.3399/bjgpopen18X101277
SGUL Authors: Drennan, Vari MacDougal

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Abstract

Background: There are limited case-mix classification systems for primary care settings which are applicable when considering the optimal clinical skill mix to provide services. Aim: To develop a case-mix classification system (CMCS) and test its impact on analyses of patient outcomes by clinician type, using example data from physician associates' (PAs) and GPs' consultations with same-day appointment patients. Design & setting: Secondary analysis of controlled observational data from six general practices employing PAs and six matched practices not employing PAs in England. Method: Routinely-collected patient consultation records (PA n = 932, GP n = 1154) were used to design the CMCS (combining problem codes, disease register data, and free text); to describe the case-mix; and to assess impact of statistical adjustment for the CMCS on comparison of outcomes of consultations with PAs and with GPs. Results: A CMCS was developed by extending a system that only classified 18.6% (213/1147) of the presenting problems in this study's data. The CMCS differentiated the presenting patient's level of need or complexity as: acute, chronic, minor problem or symptom, prevention, or process of care, applied hierarchically. Combination of patient and consultation-level measures resulted in a higher classification of acuity and complexity for 639 (30.6%) of patient cases in this sample than if using consultation level alone. The CMCS was a key adjustment in modelling the study's main outcome measure, that is rate of repeat consultation. Conclusion: This CMCS assisted in classifying the differences in case-mix between professions, thereby allowing fairer assessment of the potential for role substitution and task shifting in primary care, but it requires further validation.

Item Type: Article
Additional Information: This article is Open Access: CC BY-NC 4.0 license (https://creativecommons.org/licenses/by-nc/4.0/) Copyright © 2018, The Authors
Keywords: case-mix, classification, general practice, methods, physician assistants, physician associate
Journal or Publication Title: BJGP Open
ISSN: 2398-3795
Language: eng
Dates:
DateEvent
17 April 2018Published
14 August 2017Accepted
Publisher License: Creative Commons: Attribution-Noncommercial 4.0
Projects:
Project IDFunderFunder ID
09/1801/1066National Institute for Health Researchhttp://dx.doi.org/10.13039/501100000272
PubMed ID: 30564699
Go to PubMed abstract
URI: https://openaccess.sgul.ac.uk/id/eprint/110672
Publisher's version: https://doi.org/10.3399/bjgpopen18X101277

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