HEALTH STATUS AND SEVERITY OF ILLNESS AS PREDICTORS OF OUTCOMES IN PRIMARY-CARE

Two measures of health status and severity of illness were tested as i ndicators of patient case-mix to predict health-related outcomes in a rural primary care community health clinic, using a convenience sample of 413 ambulatory adults (mean age = 40.4 years: 58.6% women, and 47. 2% black). At baseline; patients completed the Duke Health Profile, an d providers completed the Duke Severity of Illness Checklist. During t he 18-month follow-up study, patients experienced the following outcom es: at least one follow-up visit (74.3%), more than six visits (20.6%) , at least one referral or hospital admission (17.3%), upper tertile s everity scores (24.9%), and upper tertile office charges (24.9%). Base line physical health, perceived health, and severity scores were stati stically significantly predictive of all five outcomes. Predictive acc uracy (i.e., area under the receiver operating characteristic curves) for outcome probabilities estimated from a case-mix model of physical health, severity, age, gender, and race was 72.3% for follow-up, 69.7% for frequent follow-up, 70.5% for referral and/or hospital stay, 65.7 % for high follow-up severity of illness, and 67.6% for high follow-up charges. These data support health status and severity of illness as case-mix indicators and outcome predictors of follow-up utilization, s everity of illness, and cost in the primary care setting.