Use of Latent Class Analysis and k-Means Clustering to Identify Complex Patient Profiles

Question What distinct clinical profiles can be identified within a population of the most medically complex patients? Findings In this cohort study of 104 869 individuals, data clustering methods were combined with clinical stakeholder assessment to define clinical profiles within the top 3% most medically complex adult patients in a large integrated care system: high acuity, older with cardiovascular complications, frail elderly, pain management, psychiatric illness, cancer treatment, and less engaged. These profiles had significantly different 1-year health care utilization and mortality, and each profile suggested different adjunctive care strategies. Meaning The findings suggest that a single care model may not meet the needs of adults with high comorbidity and care utilization. This cohort study uses data clustering methods and clinical stakeholder assessment to identify clinical profiles in a population of medically complex patients. Importance Medically complex patients are a heterogeneous group that contribute to a substantial proportion of health care costs. Coordinated efforts to improve care and reduce costs for this patient population have had limited success to date. Objective To define distinct patient clinical profiles among the most medically complex patients through clinical interpretation of analytically derived patient clusters. Design, Setting, and Participants This cohort study analyzed the most medically complex patients within Kaiser Permanente Northern California, a large integrated health care delivery system, based on comorbidity score, prior emergency department admissions, and predicted likelihood of hospitalization, from July 18, 2018, to July 15, 2019. From a starting point of over 5000 clinical variables, we used both clinical judgment and analytic methods to reduce to the 97 most informative covariates. Patients were then grouped using 2 methods (latent class analysis, generalized low-rank models, with k-means clustering). Results were interpreted by a panel of clinical stakeholders to define clinically meaningful patient profiles. Main Outcomes and Measures Complex patient profiles, 1-year health care utilization, and mortality outcomes by profile. Results The analysis included 104 869 individuals representing 3.3% of the adult population (mean [SD] age, 70.7 [14.5] years; 52.4% women; 39% non-White race/ethnicity). Latent class analysis resulted in a 7-class solution. Stakeholders defined the following complex patient profiles (prevalence): high acuity (9.4%), older patients with cardiovascular complications (15.9%), frail elderly (12.5%), pain management (12.3%), psychiatric illness (12.0%), cancer treatment (7.6%), and less engaged (27%). Patients in these groups had significantly different 1-year mortality rates (ranging from 3.0% for psychiatric illness profile to 23.4% for frail elderly profile; risk ratio, 7.9 [95% CI, 7.1-8.8], P < .001). Repeating the analysis using k-means clustering resulted in qualitatively similar groupings. Each clinical profile suggested a distinct collaborative care strategy to optimize management. Conclusions and Relevance The findings suggest that highly medically complex patient populations may be categorized into distinct patient profiles that are amenable to varying strategies for resource allocation and coordinated care interventions.