Table 4:

Example Analysis of Detected Contextual Anomalies (see Fig. 3 for expected vs. actual utilization levels)

ID	Age	Top Cormobidities	Anomaly Analysis
6071	48	other symptoms involving abdomen and pelvis; heart failure; essential hypertension; obesity and other hyperalimentation; nondependent abuse of drugs; ill-defined descriptions and complications of heart disease; acute bronchitis and bronchiolitis	Diabetic with advancing complications including heart failure, thus requiring large number of specialist visits. Patient is underutilizing PCP and Specialists, and appears non-compliant with poor dietary control and is likely a smoker. This person over-utilizes the ER, possibly for both diabetic and respiratory complications, as well as drug-seeking behavior.
1311	67	acquired hypothyroidism; disorders of lipoid metabolism; asthma;nontoxic nodular goiter; essential hypertension; other disorders of urethra and urinary tract; other and unspecified anemias	Older diabetic, with prior thyroidectomy and resultant hypothyroidism, plus possible urinary stress incontinence, as well as poorly controlled asthma. The latter may be due to suboptimal medication regime and/or non-compliance, resulting in unexpectedly frequent PCP and Specialist visits, and hospital admissions from the doctor’s office. Home health visits are likely for home respiratory therapy. Patient likely has been trained to contact her doctors instead of using the ER.
2815	59	other disorders of cervical region; symptoms involving head and neck; disorders of lipoid metabolism; other disorders of soft tissues; intervertebral disc disorders; other forms of chronic ischemic heart disease; gastrointestinal hemorrhage; cellulitis and abscess of finger and toe	likely a non-compliant diabetic with hyperlipidemia, cardiac disease and vascular disease leading to skin ulcers and infections. Cervical disc disease is a comorbidity. This patient over-utilizes specialists and the ER, most likely due to diabetic complications, and chronic pain related to cervical disc disease. Unexpected hospitalizations are likely due to complications related to non-compliance, and outpatient hospital visits may be related to antibiotic treatment of skin infections secondary to vascular disease and poor self-care. Alcohol abuse should also be investigated in light of the history of gastrointestinal hemorrhage