Final Research Report

View this project's final research report.

Peer-Review Summary

Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also assesses how the project addressed PCORI’s Methodology Standards. During peer review, experts read a draft report of the research and provide comments about the report. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. These reviewers cannot have conflicts of interest with the study.

The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve descriptions of the conduct of the study or to clarify the connection between results and conclusions. Sometimes, awardees revise their draft reports twice or more to address all of the reviewers’ comments.  

Peer reviewers commented and the researchers made changes or provided responses. Those comments and responses included the following:

  • The reviewers noted that when the researchers assessed the effect of social determinants of health (SDH), there were different effects whether the analytic model used community or individual SDH. The reviewers said that it was clear that if the analytic model already included individual SDH, the addition of community SDH did not have much effect. The reviewers asked for the researchers to add similar information about whether individual SDH had an effect on the results of the analytic model even when community SDH were already included in the analyses. The researchers added language to clarify that this was the case and agreed with the reviewers that individual SDH may possess a greater ability to provide actionable information to clinicians treating those patients.
  • The reviewers asked the researchers to explain how they operationalized number of emergency department visits: whether that was calculated as one or more visits, or number of visits. The researchers acknowledged that the measurement of emergency department visits was not consistent, mainly because the data were collected differently at the different sites and across different phases of the study.
  • One reviewer asked the researchers to clarify in the report that their research focused on one type of provider, community health centers. Therefore, the reviewer noted, the researchers’ advocacy for system-wide changes to ratings of provider performance metrics could lead to more resources for higher-income patients rather than resulting in more system resources going to patients with greater social complexity that could interfere with their health. The researchers agreed and clarified in the report their recommendations that system-wide reimbursement changes should not only take into account which providers had the best clinical outcomes, but also patients’ SDH, which were found to have a greater effect on outcomes than clinical complexity. 

Conflict of Interest Disclosures

Project Information

Abigail Sears, MBA, MHA and Erika Cottrell, PhD, MPP^
Oregon Community Health Information Network
The Impact of Patient Complexity on Healthcare Utilization

Key Dates

June 2016
March 2021

Study Registration Information

^The original principal investigator for this project was Scott Fields, MD, MHA.


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Last updated: May 24, 2022