Patient Attribution to Nephrology Provider

Definition

A relationship between a patient and the nephrology provider (individual, group, or both) most responsible for that patient’s nephrology-related care. If the patient has received care from multiple qualifying nephrology providers or groups, the provider or group most responsible for care is determined empirically based on their history of office visits (the algorithm favors providers with the most clinician office visits in the last two years up to a cap, with ties broken in favor of those with the most recent visit). The relationship can change over time, so a patient timeline data structure is used to capture those changes.

Purpose

Used in the URSA-CKD module to assign performance — e.g., as reflected in a clinical quality or value measure — to the responsible nephrology provider.

Related objects

• Clinician Office Visits with Nephrology Provider
• Patient Timelines of Empirical Attribution to Nephrology Provider
  • Patient Timelines of Empirical Attribution to Nephrology Provider, Precursor 1 (Individual Provider Attribution)
  • Patient Timelines of Empirical Attribution to Nephrology Provider, Precursor 2 (Provider Group Attribution)
• Patient Timelines Master for URSA-CKD Concepts
  

Detailed narrative of logic

1. The logic implemented in Patient Timelines of Empirical Attribution to Nephrology Provider, Precursor 1 (Individual Provider Attribution), Patient Timelines of Empirical Attribution to Nephrology Provider, Precursor 2 (Provider Group Attribution), and Patient Timelines of Empirical Attribution to Nephrology Providerattempts to attribute patients to both an individual nephrology provider and a nephrology provider group, if possible. First, Patient Timelines of Empirical Attribution to Nephrology Provider, Precursor 1 (Individual Provider Attribution) and Patient Timelines of Empirical Attribution to Nephrology Provider, Precursor 2 (Provider Group Attribution) independently generate patient attribution timelines for individual and organizational providers, respectively; then Patient Timelines of Empirical Attribution to Nephrology Provider combines the two into a single patient timeline. 
2. The logic implemented in Patient Timelines of Empirical Attribution to Nephrology Provider, Precursor 1 (Individual Provider Attribution) and Patient Timelines of Empirical Attribution to Nephrology Provider, Precursor 2 (Provider Group Attribution) is very similar. In both cases the interactions between the patient and provider — in the form of clinician office visits with a nephrology provider in the prior two years, obtained from Clinician Office Visits with Nephrology Provider— are collected. Patients are attributed to the provider with the plurality of visits in the last two years, up to a cap of two visits, with ties broken to favor the provider with the most recent office visit. (The cap is in place to reduce inertia in the attribution model; effectively, it means that when a patient starts to see a new provider the attribution algorithm will attribute the patient to the new provider on the date of their second visit.)
3. The logic in Patient Timelines of Empirical Attribution to Nephrology Provider, Precursor 1 (Individual Provider Attribution) and Patient Timelines of Empirical Attribution to Nephrology Provider, Precursor 2 (Provider Group Attribution) generates timelines, reflecting the dynamic nature of the attribution model — i.e., that the patient may be attributed to different providers at different times. These timelines are combined into a single timeline, Patient Timelines of Empirical Attribution to Nephrology Provider, which has a resulting grain size of one record per patient-period during which the patient had at least one clinician office visit with an individual or organizational nephrology provider.
4. Note that there is no restriction in any of this logic related to the patient’s CKD status.