The American journal of managed care
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Am J Manag Care
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Many healthcare systems use prediction models to estimate and manage patient-level probability of hospitalization. Patients identified as high-risk at one point in time may not, however, remain high-risk. We aimed to describe subgroups of patients with distinct longitudinal risk score patterns to inform interventions tailored to patients' needs. ⋯ Few patients who were high-risk for hospitalization at baseline remained so. Nonrandomized evaluations of interventions that identify patients based on a single high-risk score may spuriously appear to have positive effects. Clinical interventions may need to focus on individuals who are persistently high-risk.