By Melinda Young

Researchers developed a new tool, the Special Intensity Score, that healthcare administrators can use to determine a patient’s need for care coordination across multiple specialist doctors. It also helps with evaluation of care coordination practices.1

“We developed it, and then tested it using patient safety indicators,” says Ashley Hodgson, PhD, co-creator of the Special Intensity Score, Frank Gery associate professor economics, and department chair of economics at St. Olaf College in Northfield, MN. “Some patients need a lot more care coordination than other patients. The basic idea with this score is to identify which patients are going to need the most coordination.”

“We ask about specialists and then also about secondary conditions,” Hodgson continues. “Conceptually, this is about how many specialists you would expect to see on average based on your diagnoses.” Researchers measured ICD-10 codes to determine which specialists were needed.

The tool was developed with internal grants. The investigators have no plans to patent it — they are making the tool available for anyone to use the formula, Hodgson says.

The study included two parts. The main part involved developing the Special Intensity Score and measuring how many specialists a patient would see.

“The one way we tested it was using patient safety indicators, the Charlson Comorbidity Index, which was developed essentially as a measure of frailty — assessing the probability of death,” Hodgson explains.2 “Death isn’t what we were interested in; we were interested in care coordination and the patient’s complex needs in the health system. Basically, we wanted to see when we compare the two measures — ours and Charlson — which one is more correlated with patient safety incidents.”

Hodgson and colleagues predicted the Special Intensity Score would show a more complicated interaction with the healthcare system. They found what they expected. “Our measure is much more predictive of health safety events,” she says.

The Special Intensity Score is more statistically significant as a patient safety indicator, but it does not mean a clinician could look at the score and say that a particular patient will experience a safety incident. “It predicts that they are more likely to have an incident,” Hodgson explains.

For healthcare leaders, the bigger finding is the score could help them predict the cost of treating patients, the number of visits, and which doctors they will see.

“Basically, if a healthcare administrator is trying to predict which patient you should invest coordination efforts in, and it’s expensive to do that for everybody, our score will say which patient should receive more of the focus,” she explains. “I think the deal is, most people know that care coordination is a problem. There’s been a lot of care coordination measures, but we just don’t have good ways of measuring who’s doing it well in terms of patient outcomes and triage.”

Patients with multiple chronic conditions spend significantly more dollars in the healthcare system, but they are excluded from studies because their conditions are complicated and would make it more difficult to achieve research outcomes.

“They are so much of what our healthcare system does, and yet they’re excluded from official research trials because they’re too complicated,” Hodgson says. “We need more ways to look at and research these patients and how they are involved in the healthcare system because [most] Medicare [funding] goes to these patients with chronic conditions.”


  1. Hodgson A, Bernardin T, Westermeyer B, et al. Development of a specialty intensity score to estimate a patient’s need for care coordination across physician specialties. Health Sci Rep 2021;4:e303.
  2. Charlson Comorbidity Index. MD+CALC.