Structured Abstract

Contents

• Preface
• Acknowledgments
• Key Informants
• Technical Expert Panel
• Peer Reviewers
• Evidence Summary
  • Main Points
  • Background and Purpose
  • Methods
  • Results
• Chapter 1. Introduction
  • Background
  • Intervention Strategies
  • Clinical and Policy Context
  • Purpose and Scope of the Review
  • Report Organization
• Chapter 2. Methods
  • Key Questions
  • Analytic Framework
  • Review Approach
  • Study Selection
  • Data Sources and Searches
  • Data Extraction and Risk-of-Bias/Risk-of-Rigor Assessments
  • Data Synthesis and Analysis
  • Grading the Strength of the Body of Evidence
• Chapter 3. Results
  • Literature Searches and Study Characteristics
  • Description of Included Evidence
  • KQ 1. What criteria identify or predict that patients will be HNHC?
  • KQ 1a. How do criteria incorporate patient clinical characteristics?
  • KQ 1b. How do criteria incorporate patient demographic, behavioral health, and social risk factors?
  • KQ 1c. How do criteria incorporate types, amount, duration, and patterns of healthcare use?
  • KQ 1d. Do criteria differ when HNHC is identified at the population, payer, healthcare system, and provider levels?
  • KQ 1e. How can potentially preventable or modifiable high use of healthcare be differentiated from necessary and appropriate high use?
  • KQ 2. What are the mechanisms that lead to reductions in potentially preventable or modifiable healthcare use and result in improved health outcomes and cost savings in interventions serving HNHC patients?
  • KQ 3. Overall, what is the effectiveness and what are the harms of interventions for HNHC patients in reducing potentially preventable or modifiable healthcare use and costs and in improving health outcomes?
• Chapter 4. Discussion
  • Overview
  • Strengths and Limitations
  • Applicability
  • Implications for Clinical Practice, Education, Research, or Health Policy
  • Conclusions
• References
• Appendixes
  • Appendix A. Detailed Methods
  • Appendix B. Results
  • Appendix C. Appendix References

Suggested citation:

Berkman ND, Chang E, Seibert J, Ali R, Porterfield D, Jiang L, Wines R, Rains C, Viswanathan M. Management of High-Need, High-Cost Patients: A “Best Fit” Framework Synthesis, Realist Review, and Systematic Review. Comparative Effectiveness Review No. 246. (Prepared by the RTI International–University of North Carolina at Chapel Hill Evidence-based Practice Center under Contract No. 290-2015-00011-I.) AHRQ Publication No. 21(22)-EHC028. Rockville, MD: Agency for Healthcare Research and Quality; October 2021. DOI: https://doi.org/10.23970/AHRQEPCCER246. Posted final reports are located on the Effective Health Care Program search page.

This report is based on research conducted by the RTI International–University of North Carolina at Chapel Hill Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-2015-00011-I). The findings and conclusions in this document are those of the authors, who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.

None of the investigators have any affiliations or financial involvement that conflicts with the material presented in this report.

The information in this report is intended to help healthcare decision makers—patients and clinicians, health system leaders, and policymakers, among others—make well-informed decisions and thereby improve the quality of healthcare services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances presented by individual patients.

This report is made available to the public under the terms of a licensing agreement between the author and the Agency for Healthcare Research and Quality. This report may be used and reprinted without permission except those copyrighted materials that are clearly noted in the report. Further reproduction of those copyrighted materials is prohibited without the express permission of copyright holders.

AHRQ or U.S. Department of Health and Human Services endorsement of any derivative products that may be developed from this report, such as clinical practice guidelines, other quality enhancement tools, or reimbursement or coverage policies, may not be stated or implied.

AHRQ appreciates appropriate acknowledgment and citation of its work. Suggested language for acknowledgment: This work was based on an evidence report, Management of High-Need, High-Cost Patients: A “Best Fit” Framework Synthesis, Realist Review, and Systematic Review, by the Evidence-based Practice Center Program at the Agency for Healthcare Research and Quality (AHRQ).