“Impactibility Models”: Identifying the Subgroup of High-Risk Patients Most Amenable to Hospital-Avoidance Programs

Lewis GH. “Impactibility models”: identifying the subgroup of high-risk patients most amenable to hospital-avoidance programs. Milbank Q. 2010 Jun;88(2):240–55. 

Abstract

CONTEXT:

Predictive models can be used to identify people at high risk of unplanned hospitalization, although some of the high-risk patients they identify may not be amenable to preventive care. This study describes the development of "impactibility models," which aim to identify the subset of at-risk patients for whom preventive care is expected to be successful.

METHODS:

This research used semistructured interviews with representatives of thirty American organizations that build, use, or appraise predictive models for health care.

FINDINGS:

Impactibility models may refine the output of predictive models by (1) giving priority to patients with diseases that are particularly amenable to preventive care; (2) excluding patients who are least likely to respond to preventive care; or (3) identifying the form of preventive care best matched to each patient's characteristics.

CONCLUSIONS:

Impactibility models could improve the efficiency of hospital-avoidance programs, but they have important implications for equity and access.