eTable 1: Test Characteristics of the Overall Physician-Defined Complexity Model in the Developmental and Validation Datasets

Dataset / Accuracy / Sensitivity / Specificity / Positive Predictive Value / Negative Predictive Value
Developmental / 0.823 / 0.482 / 0.945 / 0.755 / 0.837
Validation / 0.824 / 0.466 / 0.951 / 0.771 / 0.834

eTable 2: Predictors for Physician-Defined Complexity Model in Age-Stratified Models

Variable / Age Group
<45 years old / 45-64 years old / ≥65 years old
OR [95% CI] / OR [95% CI] / OR [95% CI]
Age / ----- / ----- / 1.05 [1.02-1.07]
Married / ------/ 0.89 [0.65-1.22] / 0.88 [0.62-1.25]
Insurance (vs. Medicare)
Medicaid / 0.07 [0.02-0.22] / 0.72 [0.36-1.45] / -----
Free care / 0.03 [0.01-0.21] / 0.53 [0.13-2.26] / -----
Self-pay / 0.10 [0.02-0.44] / 1.94 [0.48-7.89] / -----
Commercial / 0.05[0.02-0.16] / 0.47 [0.27-0.82] / -----
Number of clinic visits / 1.03 [0.98-1.09] / 1.04 [1.00-1.08] / -----
Number of no show appointments during 3 years / 1.29 [1.12-1.49] / 1.11 [0.98-1.26] / 1.30 [1.06-1.59]
Number of urgent care visits in 3 years / ----- / ----- / 0.94 [0.85-1.04]
Primary care visit billed as complex / ----- / 1.79 [1.31-2.45] / 1.70 [1.18-2.45]
Co-morbidity score / ----- / 1.20 [1.03-1.41] / 1.24 [1.06-1.45]
Diabetes (validated algorithm for identifying patients with diabetes) / 2.22 [0.52-9.40] / 2.32 [1.37-3.91] / 1.84 [1.11-3.05]
Chronic obstructive pulmonary disease diagnosis coded in 3 years / ----- / ----- / 1.57 [1.01-2.43]
Liver disease diagnosis coded in 3 years / ----- / ----- / 1.77 [0.89-3.55]
Abdominal pain diagnosis coded in 3 years / 1.59 [1.01-2.50] / ----- / 1.47 [0.97-2.23]
Neck pain diagnosis coded in 3 years / 1.33 [0.76-2.30] / ----- / -----
Number of unique high-risk psychiatric* diagnoses coded in 3 years / ----- / 1.30 [1.15-1.47] / 1.18 [1.01-1.39]
Post traumatic stress disorder diagnosis coded in 3 years / 2.25 [0.84-6.05] / ----- / -----
Any high-risk behavioral health diagnosis* coded in 3 years / 1.82 [1.18-2.81] / ----- / -----
Other high-risk diagnosis** / 1.47 [0.75-2.90] / ----- / -----
Number of e-prescribed medications in 3 years** / 1.02 [0.98-1.06] / 1.07 [1.04-1.10] / 1.04 [1.01-1.08]
Warfarin prescribed in 3 years / ----- / 6.40 [1.85-22.16] / -----
Opiate medications prescribed in 3 years / 2.07 [0.41-10.37] / ----- / -----
Last hemoglobin A1c>9 / 4.91 [0.68-35.67] / ----- / -----
Computed Tomography Scan procedure coded in 3 years / 1.58 [0.97-2.58] / ----- / -----
Magnetic Resonance Imaging procedure coded in 3 years / 2.53 [1.45-4.42] / ----- / -----
Myocardial Perfusion Scan procedure coded in 3 years / ----- / ----- / 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)

eTable 3: Characteristics Clinical Quality and Utilization Outcomes of Patients Complex by Physician-defined Complexity

Variable / Complex by Physician-defined Complexity
(N = 20,840) / Not Complex by Physician-defined Complexity
(N=122,532)
Patient Characteristics
Age in years, mean (SD) / 64.0 (15.9) / 46.6 (15.7)
<45, % / 9.7 / 50.3
45-64, % / 44.9 / 34.3
≥65, % / 45.4 / 15.4
Female, % / 59.0 / 57.2
Race
White, % / 77.7 / 76.8
Black, % / 6.9 / 5.3
Hispanic, % / 10.2 / 8.6
Asian, % / 2.8 / 5.5
Other, % / 2.4 / 3.9
Primary Insurance
Commercial, % / 29.5 / 76.8
Medicare, % / 55.3 / 12.5
Medicaid/State/Free/Uninsured, % / 15.2 / 10.7
Primary Language, English, % / 87.9 / 91.8
Married, % / 41.9 / 56.0
CBG Non High School Graduation Rate
<5%, % / 14.5 / 24.8
5-25%, % / 49.3 / 47.8
≥25%, % / 23.3 / 14.2
CBG Median Household Income
<$40,000, $ / 32.9 / 20.7
$40,000-70,000, $ / 42.5 / 42.6
≥$70,000, $ / 20.0 / 33.0
≥2 Primary Care "No Shows" in 3 years, % / 33.1 / 9.3
Number of e-Prescribed medications in 3 years, mean (SD) / 21.0 (8.3) / 6.2 (6.2)
>10 Medications e-Prescribed in 3 years, % / 87.8 / 20.2
Number of e-Prescribed High-Risk Medications in 3 years, mean (SD) / 2.8 (1.9) / 0.8 (1.3)
≥1 High-Risk Medications** e-Prescribed in 3 years, % / 83.9 / 38.0
Chronic Diseases
Chronic Obstructive Pulmonary Disease, % / 32.0 / 11.4
Vascular Disease, % / 26.4 / 3.6
Depression, % / 51.9 / 17.1
Diabetes, % / 35.2 / 2.8
Hypertension, % / 52.4 / 15.9
End-stage Renal Disease or Transplant, % / 1.6 / 0.1
Any Psychiatric Diagnosis, % / 68.1 / 25.2
Cancer Screening
Breast Cancer (Rate: ppy) / 21.4 / 18.3
Cervical Cancer (Rate: ppy) / 18.4 / 14.9
Colorectal Cancer (Rate: ppy) / 24.8 / 22.5
Diabetes
LDL ≥ 130 (Rate: ppy) / 10.0 / 13.1
A1C ≥ 9 (Rate: ppy) / 12.5 / 10.1
Vascular Disease
LDL ≥ 130 (Rate: ppy) / 18.9 / 19.5
Utilization
Primary Care No-Shows (Rate: ppy) / 42.6 / 14.6
Primary Care Visits (Rate: ppy) / 4.0 / 1.9
ED Visits (Rate: ppy) / 23.6 / 7.2
Admissions (Rate: ppy) / 26.5 / 4.0
30-Day Re-admission Rate* (Rate: ppy) / 17.2 / 11.2

*All pvalues in table ≤0.001

1

