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Zhang M, Ma J, Xie F, Thabane L. Identifying factors associated with high use of acute care in Canada: a population-based retrospective study. Eur J Health Econ 2023; 24:1505-1515. [PMID: 36595151 DOI: 10.1007/s10198-022-01558-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 12/12/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVES To determine demographic, socioeconomic, and clinical factors associated with being high-cost users (HCUs) in adult patients (≥ 18 years) who received acute care in Canada. RESEARCH DESIGN We conducted a retrospective study among adults who had at least one encounter with acute care facilities each year from 2011 to 2014 using national linked data sets. We defined HCUs as patients on the top 10% of the highest acute care cost users in the province, where the care was provided. Risk factors associated with being HCUs were identified using multilevel logistic regression. Provincial variations of identified risk factors were examined using logistic regression. Sensitivity analyses were also performed to investigate the influences of using different metrics and different thresholds to define high system users, missing data, and the inclusion of interaction terms on the study results. RESULTS Between 2011 and 2014, a total of 3,891,410 patients with 6,017,430 hospitalizations were included. Patients who were male [odds ratio (OR), 1.60; 95% confidence interval (CI) 1.59-1.61], with low incomes [OR 1.42; 95% CI 1.41-1.43), with higher comorbidity score (OR 1.41; 95% CI 1.40-1.41] and older [OR 1.18; 95% CI 1.17-1.18] were more likely to be acute care HCUs. Significant interactions existed between comorbidity score and age/sex/income status. Across provinces, the associations between socioeconomic factors and being HCUs has the largest variation. When using various high system users (HSUs) definitions, the impacts of living in rural area and being visible minority on the odds of being HSUs differ. CONCLUSIONS A few demographic, socioeconomic, and clinical factors was associated with high acute care expenditures. The associations between included risk factors and being acute care HCUs vary across provinces and different definitions of high system users (HSUs).
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Affiliation(s)
- Mengmeng Zhang
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, L8S 4K1, Canada
| | - Jinhui Ma
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, L8S 4K1, Canada
| | - Feng Xie
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, L8S 4K1, Canada
- Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, ON, L8S 4K1, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, L8S 4K1, Canada.
- Biostatistics Unit/FSORC, Saint Joseph's Healthcare Hamilton, Hamilton, ON, L8N 4A6, Canada.
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Miele AS, Fleury MJ, Zeluff H, Mendieta A, Phillips C, Roth A, Basello G, Nienaber C, Crupi R, Brondolo E. Driven by need, shaped by access: Heterogeneity in patient profiles and patterns of service utilization in patients with alcohol use disorders. Drug Alcohol Depend 2023; 246:109825. [PMID: 36924662 DOI: 10.1016/j.drugalcdep.2023.109825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 02/15/2023] [Accepted: 02/17/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Patients with alcohol-use disorders (AUDs) are highly heterogenous and account for an increasing proportion of general medical hospital visits. However, many patients with AUDs do not present with severe medical or psychiatric needs requiring immediate attention. There may be a mismatch between some patients' needs and the available services, potentially driving re-admissions and re-encounters. The current study aims to identify subgroups of AUD patients and predict differences in patterns of healthcare service use (HSU) over time. METHODS Latent class analysis (LCA) was conducted using hospital data incorporating sociodemographic, health behavior, clinical, and service use variables to identify subtypes of AUD patients, then class membership was used to predict patterns of HSU. RESULTS Four classes were identified with the following characteristics: (1) Patients with acute medical injuries (30 %); (2) Patients with socioeconomic and psychiatric risk factors, (11 %); (3) Patients with chronic AUD with primarily non-psychiatric medical needs (18 %); and (4) Patients with primary AUDs with low medical-treatment complexity (40 %). Negative binomial models showed that Class 4 patients accounted for the highest frequency of service use, including significantly higher rates of emergency department reencounters at 30 days and 12 months. CONCLUSIONS The profile and patterns of HSU exhibited by patients in class 4 suggest that these patients have needs which are not currently being addressed in the emergency department. These have implications for how resources are allocated to meet the needs of patients with AUDs, including those who make frequent visits to the emergency department without high acuity medical needs.
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Affiliation(s)
- Andrew S Miele
- St. John's University Department of Psychology, Queens, NY, USA; Jamaica Hospital Medical Center (JHMC), Queens, NY, USA.
| | - Marie-Josée Fleury
- Douglas Research Center, McGill University Department of Psychiatry, Montreal, Quebec, Canada
| | - Heather Zeluff
- St. John's University Department of Psychology, Queens, NY, USA
| | - Ashley Mendieta
- St. John's University Department of Psychology, Queens, NY, USA
| | | | - Alan Roth
- Jamaica Hospital Medical Center (JHMC), Queens, NY, USA
| | - Gina Basello
- Jamaica Hospital Medical Center (JHMC), Queens, NY, USA
| | | | - Robert Crupi
- Ambulatory Care & Population Health & Palliative Care Services, Weill Cornell Medical College, USA
| | - Elizabeth Brondolo
- St. John's University Department of Psychology, Queens, NY, USA; Jamaica Hospital Medical Center (JHMC), Queens, NY, USA
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Stewart AJ, Patten SB, Fiest KM, Williamson TS, Wick JP, Ronksley PE. 10-Year Trends in Healthcare Spending among Patients with Schizophrenia in Alberta, Canada. Can J Psychiatry 2022; 67:723-733. [PMID: 35244485 PMCID: PMC9449136 DOI: 10.1177/07067437221082885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Schizophrenia is characterized by high levels of disability often resulting in increased healthcare utilization and spending. With expanding healthcare costs across all healthcare sectors, there is a need to understand how healthcare spending has changed over time. We conducted a population-based study using administrative health data from Alberta, Canada, to describe changes in medical complexity and direct healthcare spending among patients with schizophrenia over a 10-year period. METHODS A serial cross-sectional study from January 1, 2008, to December 31, 2017, was conducted to determine changes in demographic characteristics, medical complexity, and costs among all adults (18 years or older) with schizophrenia. Total healthcare spending and sector-specific costs attributable to hospitalizations, emergency department visits, practitioner billings, and prescriptions were calculated and compared over time. RESULTS Over the 10-year period the contact prevalence of patients with schizophrenia increased from 0.6% (n = 16,183) to 1.0% (n = 33,176) within the province. There was a marked change in medical complexity with the number of patients living with 3 or more comorbidities increasing from 33.0% to 47.3%. Direct annual healthcare costs increased 2-fold from 321 to 639 million CAD (493 million USD) with a 7-fold increase in medication expenditures over the 10-year time frame. As of 2017, spending on pharmaceutical treatment surpassed hospitalizations as the leading spending category in this population. CONCLUSIONS Healthcare spending among patients with schizophrenia continues to increase and may be partially attributable to growing rates of multimorbidity within this population. Although promising second-generation antipsychotic medications have entered the market, this has resulted in considerable changes in the distribution of healthcare spending over time. These findings will inform policy discussions around resource allocation and efforts to curb health spending while also improving care for patients with schizophrenia.
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Affiliation(s)
- Andrew J Stewart
- Department of Community Health Sciences, Cumming School of Medicine, 2129University of Calgary, Calgary, Canada
| | - Scott B Patten
- Department of Community Health Sciences, Cumming School of Medicine, 2129University of Calgary, Calgary, Canada.,Department of Medicine, Cumming School of Medicine, 2129University of Calgary, Calgary, Canada
| | - Kirsten M Fiest
- Department of Community Health Sciences, Cumming School of Medicine, 2129University of Calgary, Calgary, Canada
| | - Tyler S Williamson
- Department of Community Health Sciences, Cumming School of Medicine, 2129University of Calgary, Calgary, Canada
| | - James P Wick
- Department of Medicine, Cumming School of Medicine, 2129University of Calgary, Calgary, Canada
| | - Paul E Ronksley
- Department of Community Health Sciences, Cumming School of Medicine, 2129University of Calgary, Calgary, Canada
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Song M, Ware RS, Doan TN, Harley D. Characteristics associated with frequent health system use by Australian adults with intellectual disability: A cohort study. Research Intellect Disabil 2022; 35:1403-1417. [DOI: 10.1111/jar.13029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 02/23/2022] [Accepted: 07/20/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Menghuan Song
- Queensland Centre for Intellectual and Developmental Disability (QCIDD) Mater Research Institute‐University of Queensland (MRI‐UQ) South Brisbane Queensland Australia
| | - Robert S. Ware
- Queensland Centre for Intellectual and Developmental Disability (QCIDD) Mater Research Institute‐University of Queensland (MRI‐UQ) South Brisbane Queensland Australia
- Menzies Health Institute Queensland Griffith University Nathan Queensland Australia
| | - Tan N. Doan
- Department of Medicine at The Royal Melbourne Hospital University of Melbourne Melbourne Victoria Australia
| | - David Harley
- Centre for Clinical Research University of Queensland South Brisbane Queensland Australia
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Tiller R, Chan K, Knight JC, Chafe R. Pediatric high users of Canadian hospitals and emergency departments. PLoS One 2021; 16:e0251330. [PMID: 33956897 PMCID: PMC8101750 DOI: 10.1371/journal.pone.0251330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 04/23/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Few studies have examined the most frequent pediatric users of hospital services. Our objective was to determine the clinical diagnoses, demographic characteristics, and medical severity of high-use pediatric patients in Canada. METHODS We conducted a retrospective analysis of patients <18 years of age who either were admitted to hospital or visited an emergency department (ED) using the Canadian Institute for Health Information's (CIHI) Dynamic Cohort of Complex, High System Users. The analysis of hospital admission data excluded Quebec and Manitoba. ED data was only available for Alberta and Ontario. RESULTS 121 104 patients were identified as the most frequent hospital users and 459 998 patients as the most frequent ED users. High users were more likely to reside in a rural community, to be in a lower income quintile, and face more deprivation. The most frequent conditions for hospitalization for high use patients were disorders related to length of prematurity and fetal growth, respiratory and cardiovascular disorders specific to the perinatal period, and haemorrhagic and haematological disorders of fetus and newborn. For the most frequent ED users, the most common clinical diagnoses were acute upper respiratory infections, injuries to the head, and diseases of the middle ear and mastoid. CONCLUSION Pediatric high users by frequency of hospital and ED services are a distinct population. Better understanding their characteristics will allow for more appropriate planning of children's health services and help identify areas for effective preventive or quality improvement initiatives.
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Affiliation(s)
- Ryan Tiller
- Faculty of Medicine, Memorial University of Newfoundland, St. John’s, Newfoundland and Labrador, Canada
| | - Kevin Chan
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Trillium Health Partners, Mississauga, Ontario, Canada
| | - John C. Knight
- Faculty of Medicine, Memorial University of Newfoundland, St. John’s, Newfoundland and Labrador, Canada
- Newfoundland and Labrador Centre for Health Information, St. John’s, Newfoundland and Labrador, Canada
| | - Roger Chafe
- Faculty of Medicine, Memorial University of Newfoundland, St. John’s, Newfoundland and Labrador, Canada
- Janeway Pediatric Research Unit, St. John’s, Newfoundland and Labrador, Canada
- * E-mail:
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Zhang M, Ma J, Xie F, Thabane L. Identifying factors associated with high use of acute care in Canada: protocol of a population-based retrospective cohort study. BMJ Open 2020; 10:e038008. [PMID: 33060083 PMCID: PMC7566720 DOI: 10.1136/bmjopen-2020-038008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION High-cost users (HCUs) account for a small proportion of the population but use a disproportionately large share of healthcare resources. Although HCUs exist in all healthcare types, acute care is the most expensive type of service and the most significant contributor to expenditures among HCUs. This study aims to determine demographic, socioeconomic and clinical factors associated with being HCUs in adult patients (≥18 years) receiving acute care in Canada. METHODS AND ANALYSIS This is a population-based analysis using a national linked dataset. Adult patients who had at least one interaction with acute care facilities each year from 2011 to 2014 were captured in the dataset, and those living in institutions or other collective residences were not covered. The primary outcome is HCU of acute care (yes/no), which is defined as whether a patient is within the top 10% of the highest acute care cost users in his/her province. Multilevel logistic regression will be used to identify factors associated with HCU and to examine the provincial variations of these identified risk factors. Sensitivity analyses investigating the influences of different high user definitions and missing data on the study results will also be performed. ETHICS AND DISSEMINATION All researchers will follow the codes and rules set by Statistics Canada and the Research Data Centre and give priority to the confidentiality of the data during and after this study. The study findings will be published in peer-review journals and disseminated at academic conferences.
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Affiliation(s)
- Mengmeng Zhang
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Jinhui Ma
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Feng Xie
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Ontario, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Biostatistics Unit/FSORC, Saint Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
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Moita B, Marques AP, Camacho AM, Leão Neves P, Santana R. One-year rehospitalisations for congestive heart failure in Portuguese NHS hospitals: a multilevel approach on patterns of use and contributing factors. BMJ Open 2019; 9:e031346. [PMID: 31481570 PMCID: PMC6731885 DOI: 10.1136/bmjopen-2019-031346] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES Identification of rehospitalisations for heart failure and contributing factors flags health policy intervention opportunities designed to deliver care at a most effective and efficient level. Recognising that heart failure is a condition for which timely and appropriate outpatient care can potentially prevent the use of inpatient services, we aimed to determine to what extent comorbidities and material deprivation were predictive of 1 year heart failure specific rehospitalisation. SETTING All Portuguese mainland National Health Service (NHS) hospitals. PARTICIPANTS A total of 68 565 hospitalisations for heart failure principal cause of admission, from 2011 to 2015, associated to 45 882 distinct patients aged 18 years old or over. OUTCOME MEASURES We defined 1 year specific heart failure rehospitalisation and time to rehospitalisation as outcome measures. RESULTS Heart failure principal diagnosis admissions accounted for 1.6% of total hospital NHS budget, and over 40% of this burden is associated to patients rehospitalised at least once in the 365-day follow-up period. 22.1% of the patients hospitalised for a principal diagnosis of heart failure were rehospitalised for the same cause at least once within 365 days after previous discharge. Nearly 55% of rehospitalised patients were readmitted within 3 months. Results suggest a mediation effect between material deprivation and the chance of 1 year rehospitalisation through the effect that material deprivation has on the prevalence of comorbidities. Heart failure combined with chronic kidney disease or chronic obstructive pulmonary disease increases by 2.8 and 2.2 times, respectively, the chance of the patient becoming a frequent user of inpatient services for heart failure principal cause of admission. CONCLUSIONS One-fifth of patients admitted for heart failure are rehospitalised due to heart failure exacerbation. While the role of material deprivation remained unclear, comorbidities considered increased the chance of 1 year heart failure specific rehospitalisation, in particular, chronic kidney disease and chronic obstructive pulmonary disease.
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Affiliation(s)
- Bruno Moita
- Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Lisboa, Portugal
- Centro Hospitalar Universitário do Algarve, Faro, Portugal
| | - Ana Patricia Marques
- Departamento de Políticas e Gestão dos Sistemas de Saúde, Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Lisboa, Portugal
- Centro de Investigação em Saúde Pública, Universidade Nova de Lisboa, Lisboa, Portugal
| | | | - Pedro Leão Neves
- Centro Hospitalar Universitário do Algarve, Faro, Portugal
- Departamento de Ciências Biomédicas e Medicina, Universidade do Algarve, Faro, Portugal
| | - Rui Santana
- Departamento de Políticas e Gestão dos Sistemas de Saúde, Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Lisboa, Portugal
- Centro de Investigação em Saúde Pública, Universidade Nova de Lisboa, Lisboa, Portugal
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Ng SHX, Rahman N, Ang IYH, Sridharan S, Ramachandran S, Wang DD, Tan CS, Toh SA, Tan XQ. Characterization of high healthcare utilizer groups using administrative data from an electronic medical record database. BMC Health Serv Res 2019; 19:452. [PMID: 31277649 PMCID: PMC6612067 DOI: 10.1186/s12913-019-4239-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 06/10/2019] [Indexed: 12/11/2022] Open
Abstract
Background High utilizers (HUs) are a small group of patients who impose a disproportionately high burden on the healthcare system due to their elevated resource use. Identification of persistent HUs is pertinent as interventions have not been effective due to regression to the mean in majority of patients. This study will use cost and utilization metrics to segment a hospital-based patient population into HU groups. Methods The index visit for each adult patient to an Academic Medical Centre in Singapore during 2006 to 2012 was identified. Cost, length of stay (LOS) and number of specialist outpatient clinic (SOC) visits within 1 year following the index visit were extracted and aggregated. Patients were HUs if they exceeded the 90th percentile of any metric, and Non-HU otherwise. Seven different HU groups and a Non-HU group were constructed. The groups were described in terms of cost and utilization patterns, socio-demographic information, multi-morbidity scores and medical history. Logistic regression compared the groups’ persistence as a HU in any group into the subsequent year, adjusting for socio-demographic information and diagnosis history. Results A total of 388,162 patients above the age of 21 were included in the study. Cost-LOS-SOC HUs had the highest multi-morbidity and persistence into the second year. Common conditions among Cost-LOS and Cost-LOS-SOC HUs were cardiovascular disease, acute cerebrovascular disease and pneumonia, while most LOS and LOS-SOC HUs were diagnosed with at least one mental health condition. Regression analyses revealed that HUs across all groups were more likely to persist compared to Non-HUs, with stronger relationships seen in groups with high SOC utilization. Similar trends remained after further adjustment. Conclusion HUs of healthcare services are a diverse group and can be further segmented into different subgroups based on cost and utilization patterns. Segmentation by these metrics revealed differences in socio-demographic characteristics, disease profile and persistence. Most HUs did not persist in their high utilization, and high SOC users should be prioritized for further longitudinal analyses. Segmentation will enable policy makers to better identify the diverse needs of patients, detect gaps in current care and focus their efforts in delivering care relevant and tailored to each segment. Electronic supplementary material The online version of this article (10.1186/s12913-019-4239-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sheryl Hui-Xian Ng
- Centre for Health Services and Policy Research, Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Nabilah Rahman
- Centre for Health Services and Policy Research, Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Ian Yi Han Ang
- Regional Health System Office, National University Health System, Singapore, Singapore
| | - Srinath Sridharan
- Centre for Health Services and Policy Research, Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Sravan Ramachandran
- Centre for Health Services and Policy Research, Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Debby D Wang
- Centre for Health Services and Policy Research, Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Chuen Seng Tan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Sue-Anne Toh
- Regional Health System Office, National University Health System, Singapore, Singapore
| | - Xin Quan Tan
- Regional Health System Office, National University Health System, Singapore, Singapore. .,Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore.
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Affiliation(s)
- Michael Rothberg
- Center for Value-Based Care Research, Cleveland Clinic, Cleveland, Ohio, USA
| | - Natalie Lee
- Department of Medicine, Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA
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