729 Critical Patients - Comprehensive Analysis

🎯 EXECUTIVE SUMMARY

729 patients identified as requiring IMMEDIATE intervention

100% Never returned for follow-up care despite high-risk medications
100.0% Never-visit rate across all critical patients
High-risk medications with potential safety concerns
Comprehensive risk factors requiring multi-modal intervention

729 Critical Patients

30.8 Average Age (years)

81.1% HTN History Rate

365 Largest Racial Group

👥 DEMOGRAPHIC CHARACTERISTICS

Age distribution showing concentration in reproductive years

📊 Age Analysis

Mean Age: 30.8 years
Age Range: 17 - 44 years
Most Common Age Group: 30-34 years
Standard Deviation: 6.0 years

Racial and ethnic distribution of critical patients

Insurance payor distribution highlighting access patterns

👤 PATIENT JOURNEY ANALYSIS

🛤️ Typical Patient Pathways

Analysis of 5 typical patient journey patterns showing complexity, medications, age, and risk factors

📋 Detailed Journey Profiles:

Journey 1: Early Pregnancy HTN - Access Barriers - Young White Patient (Age 18, White, SUNSHINE HEALTH FL M...)\n Medications: 1 (Max Severity: 3.0)\n Comorbidities: None\n SDOH Barriers: No\n Primary Meds: Labetalol\n\nJourney 2: Complex Multi-Drug Management - Black/African American Patient (Age 28, Black or African American, BLUE CROSS TX...)\n Medications: 2 (Max Severity: 3.0)\n Comorbidities: None\n SDOH Barriers: No\n Primary Meds: Nifedipine, Labetalol\n\nJourney 3: Financial Barriers to Care - Self-Pay Patient (Age 39, Other, Self-Pay...)\n Medications: 2 (Max Severity: 3.0)\n Comorbidities: None\n SDOH Barriers: Yes\n Primary Meds: Nifedipine, Labetalol\n\nJourney 4: Complex Medical History - Older Patient with Comorbidities (Age 36, White, BLUE CROSS KC...)\n Medications: 1 (Max Severity: 3.0)\n Comorbidities: T1D, T2D\n SDOH Barriers: Yes\n Primary Meds: Labetalol\n\nJourney 5: Multi-Barrier Complex Case - High-Risk Meds + SDOH Barriers (Age 29, White, AETNA BETTER HEALTH ...)\n Medications: 1 (Max Severity: 3.0)\n Comorbidities: None\n SDOH Barriers: Yes\n Primary Meds: Labetalol\n

💡 Journey Insights:

Complexity Patterns: Multi-factor risk combinations requiring coordinated interventions
Demographic Diversity: Different age groups and racial backgrounds with unique challenges
Financial Barriers: Self-pay patients face additional access obstacles
Medication Burden: Complex medication regimens varying from 1-4+ medications per patient
Social Determinants: SDOH barriers compound clinical complexity

🏘️ SOCIAL DETERMINANTS OF HEALTH

📋 SDOH Overview

Total SDOH Records: 2,051
Unique Patients: 440
SDOH Variables: 4
Data Coverage: 60.4% of critical patients

🏥 DIAGNOSIS HISTORY & COMORBIDITIES

🩺 Primary Conditions

Hypertension History: 591 patients (81.1%)
CKD: 23 patients (3.1%)
ANGINA: 3 patients (0.4%)
MI: 9 patients (1.2%)
STROKE: 4 patients (0.5%)
T1D: 9 patients (1.2%)
T2D: 40 patients (5.5%)
TIA: 4 patients (0.5%)
CHF: 25 patients (3.4%)

💊 MEDICATION ANALYSIS

Medication severity distribution showing high-risk medication usage

💊 Medication Patterns

Total Medication Records: 1,340
Severity 0.0 Medications: 4 records (0.3%)
Severity 1.0 Medications: 388 records (29.0%)
Severity 2.0 Medications: 51 records (3.8%)
Severity 3.0 Medications: 897 records (66.9%)
Average HTN Medications per Patient: 1.8
Maximum HTN Medications: 37

🕐 Medication Timeframes

6 Months: 1,048 records (78.2%)
6 Weeks: 216 records (16.1%)
12 Months: 76 records (5.7%)

⚠️ CLINICAL RISK ASSESSMENT

🎯 Risk Prioritization

Never-Visit Rate: 100.0% (729 patients)
High Risk Group: 729 patients (100.0%)

🎯 KEY CLINICAL INSIGHTS

High-Risk Population: 729 patients with complex medication needs
Care Gap: 100% lost to follow-up care despite ongoing medication needs
Safety Concern: High-risk medications without clinical oversight
Intervention Priority: Immediate contact and clinical assessment required

📋 RECOMMENDED INTERVENTIONS

🚨 Immediate Actions (24-48 Hours)

Patient Contact: Emergency outreach to all 729 patients
Medication Review: Comprehensive medication reconciliation
Safety Assessment: Blood pressure and symptom evaluation
Care Coordination: Schedule follow-up appointments

📊 System Improvements

Enhanced Tracking: Automated alerts for high-risk patients
Care Protocols: Specialized follow-up for pregnancy-related HTN
Risk Stratification: Implement comprehensive risk scoring
Quality Metrics: Track never-visit rates as key performance indicator

729 Critical Patients - Comprehensive Analysis Report
Generated by Healthcare Analytics Team | Population Health Initiative

Data Sources: Base Population, Cohort, Medications, SDOH, Laboratory, and Vital Signs

🚨 729 Critical Patients - Comprehensive Analysis