eTable 1: Test Characteristics of the Overall Physician-Defined Complexity Model in the Developmental and
Validation Datasets
Dataset
Developmental
Validation
Accuracy
Sensitivity
Specificity
0.823
0.824
0.482
0.466
0.945
0.951
Positive
Predictive
Value
0.755
0.771
Negative
Predictive
Value
0.837
0.834
1
eTable 2: Predictors for Physician-Defined Complexity Model in Age-Stratified Models
Variable
Age
Married
Insurance (vs. Medicare)
Medicaid
Free care
Self-pay
Commercial
Number of clinic visits
Number of no show appointments during 3 years
Number of urgent care visits in 3 years
Primary care visit billed as complex
Co-morbidity score
Diabetes (validated algorithm for identifying patients with
diabetes)
Chronic obstructive pulmonary disease diagnosis coded in
3 years
Liver disease diagnosis coded in 3 years
Abdominal pain diagnosis coded in 3 years
Neck pain diagnosis coded in 3 years
Number of unique high-risk psychiatric* diagnoses coded
in 3 years
Post traumatic stress disorder diagnosis coded in 3 years
Any high-risk behavioral health diagnosis* coded in 3
years
<45 years old
OR [95% CI]
----------
Age Group
45-64 years old
OR [95% CI]
----0.89 [0.65-1.22]
≥65 years old
OR [95% CI]
1.05 [1.02-1.07]
0.88 [0.62-1.25]
0.07 [0.02-0.22]
0.03 [0.01-0.21]
0.10 [0.02-0.44]
0.05[0.02-0.16]
1.03 [0.98-1.09]
1.29 [1.12-1.49]
------------2.22 [0.52-9.40]
0.72 [0.36-1.45]
0.53 [0.13-2.26]
1.94 [0.48-7.89]
0.47 [0.27-0.82]
1.04 [1.00-1.08]
1.11 [0.98-1.26]
----1.79 [1.31-2.45]
1.20 [1.03-1.41]
2.32 [1.37-3.91]
--------------------1.30 [1.06-1.59]
0.94 [0.85-1.04]
1.70 [1.18-2.45]
1.24 [1.06-1.45]
1.84 [1.11-3.05]
-----
-----
1.57 [1.01-2.43]
----1.59 [1.01-2.50]
1.33 [0.76-2.30]
-----
------------1.30 [1.15-1.47]
1.77 [0.89-3.55]
1.47 [0.97-2.23]
----1.18 [1.01-1.39]
2.25 [0.84-6.05]
1.82 [1.18-2.81]
---------
---------
2
Other high-risk diagnosis**
Number of e-prescribed medications in 3 years**
Warfarin prescribed in 3 years
Opiate medications prescribed in 3 years
Last hemoglobin A1c>9
Computed Tomography Scan procedure coded in 3 years
Magnetic Resonance Imaging procedure coded in 3 years
Myocardial Perfusion Scan procedure coded in 3 years
1.47 [0.75-2.90]
1.02 [0.98-1.06]
----2.07 [0.41-10.37]
4.91 [0.68-35.67]
1.58 [0.97-2.58]
2.53 [1.45-4.42]
-----
----1.07 [1.04-1.10]
6.40 [1.85-22.16]
---------------------
----1.04 [1.01-1.08]
--------------------0.61 [0.38-0.98]
*High-risk behavioral health diagnoses = ICD-9 billing code or problem list diagnosis of: anxiety, post-traumatic stress
disorder, bipolar disorder, dementia, depression, drug or alcohol addiction-related conditions, personality disorder,
schizophrenia or other psychotic disorders, chronic pain, eating disorders, or history of domestic violence
**The total number of unique medications electronically prescribed during a 3-year period.
**Other high-risk diagnoses = ICD-9 billing code or problem list diagnosis of noncompliance, situational
stress/depression/anxiety or adjustment reactions, attention deficit disorder, dementia, marijuana use, history of drug or
alcohol addiction (e.g. in remission)
3
eTable 3: Characteristics Clinical Quality and Utilization Outcomes of Patients Complex by Physician-defined
Complexity
Variable
Patient Characteristics
Age in years, mean (SD)
<45, %
45-64, %
≥65, %
Female, %
Race
White, %
Black, %
Hispanic, %
Asian, %
Other, %
Primary Insurance
Commercial, %
Medicare, %
Medicaid/State/Free/Uninsured, %
Primary Language, English, %
Married, %
CBG Non High School Graduation Rate
<5%, %
5-25%, %
≥25%, %
CBG Median Household Income
Complex by
Physiciandefined
Complexity
(N = 20,840)
Not Complex by
Physiciandefined
Complexity
(N=122,532)
64.0 (15.9)
9.7
44.9
45.4
59.0
46.6 (15.7)
50.3
34.3
15.4
57.2
77.7
6.9
10.2
2.8
2.4
76.8
5.3
8.6
5.5
3.9
29.5
55.3
15.2
87.9
41.9
76.8
12.5
10.7
91.8
56.0
14.5
49.3
23.3
24.8
47.8
14.2
4
<$40,000, $
$40,000-70,000, $
≥$70,000, $
≥2 Primary Care "No Shows" in 3 years, %
Number of e-Prescribed medications in 3 years, mean (SD)
>10 Medications e-Prescribed in 3 years, %
Number of e-Prescribed High-Risk Medications in 3 years, mean (SD)
≥1 High-Risk Medications** e-Prescribed in 3 years, %
Chronic Diseases
Chronic Obstructive Pulmonary Disease, %
Vascular Disease, %
Depression, %
Diabetes, %
Hypertension, %
End-stage Renal Disease or Transplant, %
Any Psychiatric Diagnosis, %
Cancer Screening
Breast Cancer (Rate: ppy)
Cervical Cancer (Rate: ppy)
Colorectal Cancer (Rate: ppy)
Diabetes
LDL ≥ 130 (Rate: ppy)
A1C ≥ 9 (Rate: ppy)
Vascular Disease
LDL ≥ 130 (Rate: ppy)
Utilization
Primary Care No-Shows (Rate: ppy)
Primary Care Visits (Rate: ppy)
ED Visits (Rate: ppy)
Admissions (Rate: ppy)
30-Day Re-admission Rate* (Rate: ppy)
32.9
42.5
20.0
33.1
21.0 (8.3)
87.8
2.8 (1.9)
83.9
20.7
42.6
33.0
9.3
6.2 (6.2)
20.2
0.8 (1.3)
38.0
32.0
26.4
51.9
35.2
52.4
1.6
68.1
11.4
3.6
17.1
2.8
15.9
0.1
25.2
21.4
18.4
24.8
18.3
14.9
22.5
10.0
12.5
13.1
10.1
18.9
19.5
42.6
4.0
23.6
26.5
17.2
14.6
1.9
7.2
4.0
11.2
5
*All pvalues in table ≤0.001
6