Two-year change in latent classes of comorbidity among high-risk Veterans in primary care: a brief report

Abstract

Abstract Background Segmentation models such as latent class analysis are an increasingly popular approach to inform group-tailored interventions for high-risk complex patients. Multiple studies have identified clinically meaningful high-risk segments, but few have evaluated change in groupings over time. Objectives To describe population-level and individual change over time in latent comorbidity groups among Veterans at high-risk of hospitalization in the Veterans Health Administration (VA). Research design Using a repeated cross-sectional design, we conducted a latent class analysis of chronic condition diagnoses. We compared latent class composition, patient high-risk status, and patient class assignment in 2018 to 2020. Subjects Two cohorts of eligible patients were selected: those active in VA primary care and in the top decile of predicted one-year hospitalization risk in 2018 (n = 951,771) or 2020 (n = 978,771). Measures Medical record data were observed from January 2016–December 2020. Latent classes were modeled using indicators for 26 chronic health conditions measured with a 2-year lookback period from study entry. Results Five groups were identified in both years, labeled based on high prevalence conditions: Cardiometabolic (23% in 2018), Mental Health (18%), Substance Use Disorders (16%), Low Diagnosis (25%), and High Complexity (10%). The remaining 8% of 2018 patients were not assigned to a group due to low predicted probability. Condition prevalence overall and within groups was stable between years. However, among the 563,725 patients identified as high risk in both years, 40.8% (n = 230,185) had a different group assignment in 2018 versus 2020. Conclusions In a repeated latent class analysis of nearly 1 million Veterans at high-risk for hospitalization, population-level groups were stable over two years, but individuals often moved between groups. Interventions tailored to latent groups need to account for change in patient status and group assignment over time.