1 00:00:04,500 --> 00:00:08,950 Let us see what we learn about the patterns that emerge. 2 00:00:08,950 --> 00:00:12,180 We will show that the clusters are interpretable 3 00:00:12,180 --> 00:00:14,990 and reveal unique patterns of diagnostic history 4 00:00:14,990 --> 00:00:16,670 among the population. 5 00:00:16,670 --> 00:00:22,350 We selected six patterns to present in this lecture-- 6 00:00:22,350 --> 00:00:25,860 Cluster 1, 6, and 7, in Cost Bucket 2, 7 00:00:25,860 --> 00:00:28,930 and Clusters 4, 5, and 10, in Cost Bucket 3. 8 00:00:32,330 --> 00:00:35,310 The first pattern shows the occurrence of chest pain 9 00:00:35,310 --> 00:00:37,890 three months before the heart attack. 10 00:00:37,890 --> 00:00:42,420 Note that the red dots depict the visits per diagnosis 11 00:00:42,420 --> 00:00:44,720 for patients in Cluster 1-- this is, we think, 12 00:00:44,720 --> 00:00:48,350 Bucket 2-- and the blue dots depict the visits 13 00:00:48,350 --> 00:00:52,260 per diagnosis for patients in Bucket 2 throughout. 14 00:00:52,260 --> 00:00:54,430 Note the very significant increase 15 00:00:54,430 --> 00:00:56,850 for visits related to chest pains 16 00:00:56,850 --> 00:00:59,290 three months before the event. 17 00:00:59,290 --> 00:01:04,910 About 17, three months before for the red patients, 18 00:01:04,910 --> 00:01:08,460 and about 1 and 1/2 visits for the blue patients. 19 00:01:12,710 --> 00:01:15,650 The next pattern reveals an increasing occurrence 20 00:01:15,650 --> 00:01:21,570 of chronic obstructive pulmonary disease, COPD, for short. 21 00:01:21,570 --> 00:01:24,240 Patients from Cluster 7 in Bucket 2 22 00:01:24,240 --> 00:01:27,640 have regular doctor visits for COPD. 23 00:01:27,640 --> 00:01:33,030 Note that nine months before, we have 24 00:01:33,030 --> 00:01:38,160 4 and 1/2 visits versus 0.5 visits. 25 00:01:38,160 --> 00:01:43,110 Six months before, we have almost 7 visits versus 1/2 26 00:01:43,110 --> 00:01:45,680 a visit, and three months before, we 27 00:01:45,680 --> 00:01:50,509 have 9 visits versus 1/2 a visit for COPD, 28 00:01:50,509 --> 00:01:54,190 so a clear increasing pattern. 29 00:01:54,190 --> 00:01:57,910 The next pattern shows gradually increasing occurrence 30 00:01:57,910 --> 00:01:59,350 of anemia. 31 00:01:59,350 --> 00:02:02,500 The red line shows the patient's in Cluster 4 32 00:02:02,500 --> 00:02:06,530 increasingly visit the doctor for anemia from nine months 33 00:02:06,530 --> 00:02:08,389 on before the event. 34 00:02:08,389 --> 00:02:11,600 Nine months before, members have an average of 9 visits 35 00:02:11,600 --> 00:02:12,740 to the doctor for anemia. 36 00:02:17,430 --> 00:02:23,620 This increases to an average of 11 visits six months 37 00:02:23,620 --> 00:02:25,970 before the event, and then an average of 15 38 00:02:25,970 --> 00:02:29,600 visits three months before the event, a clear increasing 39 00:02:29,600 --> 00:02:30,100 pattern. 40 00:02:36,430 --> 00:02:39,370 The final pattern shows the occurrence of diabetes 41 00:02:39,370 --> 00:02:41,210 as a pattern for heart attacks. 42 00:02:41,210 --> 00:02:45,320 It is well known that both types 1 and 2 43 00:02:45,320 --> 00:02:49,170 diabetes are associated with accelerated atherosclerosis, 44 00:02:49,170 --> 00:02:53,250 one of the main causes of myocardial infarction-- heart 45 00:02:53,250 --> 00:02:54,800 attacks, that is. 46 00:02:54,800 --> 00:02:57,180 Well known diagnoses associated with heart attacks, 47 00:02:57,180 --> 00:03:00,430 such as diabetes, hypertension, and hyperlipidemia, 48 00:03:00,430 --> 00:03:03,700 characterize many of the patterns of the consistency 49 00:03:03,700 --> 00:03:08,730 of care throughout all of the cost buckets and clustering 50 00:03:08,730 --> 00:03:09,230 models. 51 00:03:13,630 --> 00:03:15,970 You observe a difference, here, of the number 52 00:03:15,970 --> 00:03:19,480 of visits for diabetes for the population 53 00:03:19,480 --> 00:03:23,090 that had the event versus the other population.