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"Adjusted clinical groups"

Daniel I McIsaac, Husein Moloo, Gregory L Bryson, Carl van Walraven
BACKGROUND: Older patients undergoing emergency general surgery (EGS) experience high rates of postoperative morbidity and mortality. Studies focused primarily on elective surgery indicate that frailty is an important predictor of adverse outcomes in older surgical patients. The population-level effect of frailty on EGS is poorly described. Therefore, our objective was to measure the association of preoperative frailty with outcomes in a population of older patients undergoing EGS. METHODS: We created a population-based cohort study using linked administrative data in Ontario, Canada, that included community-dwelling individuals aged >65 years having EGS...
May 2017: Anesthesia and Analgesia
Melissa Dattalo, Eva DuGoff, Katie Ronk, Korey Kennelty, Andrea Gilmore-Bykovskyi, Amy J Kind
OBJECTIVES: To determine the extent of agreement between four commonly used definitions of multiple chronic conditions (MCCs) and compare each definition's ability to predict 30-day hospital readmissions. DESIGN: Retrospective cohort study. SETTING: National Medicare claims data. PARTICIPANTS: Random sample of Medicare beneficiaries discharged from the hospital from 2005 to 2009 (n = 710,609). MEASUREMENTS: Baseline chronic conditions were determined for each participant using four definitions of MCC...
April 2017: Journal of the American Geriatrics Society
Daniel I McIsaac, Duminda N Wijeysundera, Allen Huang, Gregory L Bryson, Carl van Walraven
BACKGROUND: Frailty is a risk factor for adverse postoperative outcomes. Hospitals that perform higher volumes of surgery have better outcomes than low-volume providers. We hypothesized that frail patients undergoing elective surgery at hospitals that cared for a higher volume of similarly frail patients would have improved outcomes. METHODS: We conducted a retrospective, population-based cohort study using linked administrative data in Ontario, Canada. We identified all adult major, elective noncardiac surgery patients who were frail according to the validated Johns Hopkins Adjusted Clinical Groups (ACG) frailty-defining diagnoses indicator...
April 2017: Anesthesiology
Aren Fischer, Michel Cloutier, Jason Goodfield, Richard Borrelli, Dawn Marvin, Alison Dziarmaga
OBJECTIVE: To estimate the direct healthcare cost and resource use from the public payer perspective between patients with incident gout and matched gout-free patients in Ontario. METHODS: Patients with incident gout aged ≥ 66 with uninterrupted Ontario Health Insurance Plan (OHIP) coverage in the 1-year baseline period were included in the study. Patients with gout were indexed at first gout diagnosis or prescription over the study period April 1, 2008, to March 31, 2014...
January 2017: Journal of Rheumatology
Paul Y Takahashi, Herbert C Heien, Lindsey R Sangaralingham, Nilay D Shah, James M Naessens
OBJECTIVES: With the advent of healthcare payment reform, identifying high-risk populations has become more important to providers. Existing risk-prediction models often focus on chronic conditions. This study sought to better understand other factors to improve identification of the highest risk population. STUDY DESIGN: A retrospective cohort study of a paneled primary care population utilizing 2010 data to calibrate a risk prediction model of hospital and emergency department (ED) use in 2011...
July 2016: American Journal of Managed Care
Finlay A McAlister, Erik Youngson, Dean T Eurich
As choosing wisely has raised the issue of whether some individuals with type 2 diabetes may be overtreated, we examined the intensity of glycemic control across health status strata defined by comorbidities or frailty.This is a retrospective cohort study of commercially insured patients from 50 US states (Clinformatics Data Mart). We evaluated treated HbA1c levels in adults with new diabetes diagnosed between January 2004 and December 2009 who had HbA1C measured after at least 1 year of follow-up.Of 191,590 individuals with diabetes, 78...
June 2016: Medicine (Baltimore)
Scot H Simpson, Mu Lin, Dean T Eurich
BACKGROUND: Previous outcomes-based studies of adherence to diabetes medications have focused on glycemic control and are limited by questions of temporality and uncontrolled confounding. OBJECTIVE: This retrospective cohort study of new oral antidiabetic medication users examined the effect of adherence on risk of incident macrovascular and microvascular complications. METHODS: A nationwide integrated insurance claims and laboratory database was used to identify new oral antidiabetic medication users between January 2004 and December 2009...
September 2016: Annals of Pharmacotherapy
Emilio Santelices C, Fernando Muñoz P, Patricio Muñiz, José Rojas
BACKGROUND: Health care must be provided with strong primary health care models, emphasizing prevention and a continued, integrated and interdisciplinary care. Tools should be used to allow a better planning and more efficient use of resources. AIM: To assess risk adjustment methodologies, such as the Adjusted Clinical Groups (ACG) developed by The Johns Hopkins University, to allow the identification of chronic condition patterns and allocate resources accordingly...
March 2016: Revista Médica de Chile
Elzbieta Kaszuba, Håkan Odeberg, Lennart Råstam, Anders Halling
BACKGROUND: Despite the fact that heart failure and chronic obstructive pulmonary disease (COPD) often exist together and have serious clinical and economic implications, they have mostly been studied separately. Our aim was to study prevalence of coexisting heart failure and COPD in a Swedish population. A further goal was to describe levels of other comorbidity and investigate where the patients received care: primary, secondary care or both. METHODS: We conducted a register-based, cross-sectional study...
April 12, 2016: BMC Research Notes
Peder Ahnfeldt-Mollerup, Jesper Lykkegaard, Anders Halling, Kim Rose Olsen, Troels Kristensen
BACKGROUND: Chronic obstructive pulmonary disease is a leading cause of mortality, and associated with increased healthcare utilization and healthcare expenditure. In several countries, morbidity-based systems have changed the way resources are allocated in general practice. In primary care, fee-for-services tariffs are often based on political negotiation rather than costing systems. The potential for comprehensive measures of patient morbidity to explain variation in negotiated expenditures for patients with chronic obstructive pulmonary disease has not previously been examined...
April 6, 2016: BMC Health Services Research
Daniel I McIsaac, Gregory L Bryson, Carl van Walraven
IMPORTANCE: Single-center studies identify frailty as a risk factor for 30-day postoperative mortality. The long-term and population-level effect of frailty on postoperative mortality is, to our knowledge, poorly described, as are the interactions of frailty with important predictors of mortality. OBJECTIVE: To measure the population-level effect of patient frailty on, and its association with, 1-year postoperative mortality. DESIGN, SETTING, AND PARTICIPANTS: Population-based retrospective cohort study in Ontario, Canada, with data collected between April 1, 2002 and March 31, 2012...
June 1, 2016: JAMA Surgery
Andrzej Zielinski, Anders Halling
BACKGROUND: Home health care is an important part of primary health care. How delivery of home health care is organised is probably important for sustainability of the healthcare system as a whole. More than 50 % of individuals over 65 years old have multimorbidity, which increases with higher age, also influencing the needs of home health care. Our aim was to study the proportion of the population above 65 years receiving home health care according to age, gender and multimorbidity level...
2015: BMC Research Notes
Aaron K Ho, Carolyn T Thorpe, Nancy Pandhi, Mari Palta, Maureen A Smith, Heather M Johnson
OBJECTIVE: The presence of a mental health disorder with hypertension is associated with higher cardiovascular disease mortality than hypertension alone. Although earlier detection of hypertension has been demonstrated in patients with anxiety and depression, the relationship of mental health disorders to hypertension control is unknown. Our objective was to evaluate rates and predictors of incident hypertension control among patients with anxiety and/or depression compared with patients without either mental health diagnosis...
November 2015: Journal of Hypertension
Vicente del Saz Moreno, Ángel Alberquilla Menéndez-Asenjo, Ana M Camacho Hernández, David Lora Pablos, Rafael Enríquez de Salamanca Lorente, Purificación Magán Tapia
OBJECTIVE: To determine if the process of care in primary health, affects the risk of avoidable hospitalizations for ambulatory care sensitive conditions (ACSH) for heart failure (HF). DESIGN: Case-control study analyzing the risk of hospitalization for HF. The exposure factor was the process of care for HF in primary health. LOCATION: Health area of the region of Madrid (n=466.901). PARTICIPANTS: There were included all adult patients (14 years or older) with a documented diagnosis of HF in the electronic medical record of primary health (n=3...
February 2016: Atencion Primaria
Edurne Alonso-Morán, Juan F Orueta, Roberto Nuño-Solinís
BACKGROUND: Hypoglycaemia is an acute complication of diabetes mellitus which poses a serious threat. This study aims to describe the annual rate of people suffering episodes of severe hypoglycaemia and to estimate the healthcare costs for individuals who have suffered such events. METHODS: A descriptive study involving all patients with type 2 diabetes (T2DM) from the Basque Country (period: 1/09/2010 to 31/08/2011) aged ≥35 years (N = 134,413). The rate of hypoglycaemic episodes treated in hospitals (Accident and Emergency and in-patient services) was calculated using an algorithm based on diagnostics and laboratory tests...
2015: BMC Health Services Research
Martin Fredriksson, Marcus Edenström, Anneth Lundahl, Lars Björkman
We describe a method, which uses already existent administrative data to identify individuals with a high risk of a large need of healthcare in the coming year. The model is based on the ACG (Adjusted Clinical Groups) system to identify the high-risk patients. We have set up a model where we combine the ACG system stratification analysis tool RUB (Resource Utilization Band) and Probability High Total Cost >0.5. We tested the method with historical data, using 2 endpoints, either >19 physical visits anywhere in the healthcare system in the coming 12 months or more than 2 hospital admissions in the coming 12 months...
2015: Läkartidningen
Luis A Gimeno-Feliu, Amaia Calderón-Larrañaga, Esperanza Diaz, Beatriz Poblador-Plou, Rosa Macipe-Costa, Alexandra Prados-Torres
OBJECTIVE: To compare the morbidity burden of immigrants and natives residing in Aragón, Spain, based on patient registries in primary care, which represents individuals' first contact with the health system. METHODS: A retrospective observational study was carried out, based on linking electronic primary care medical records to patients' health insurance cards. The study population consisted of the entire population assigned to general practices in Aragón, Spain (1,251,540 individuals, of whom 12% were immigrants)...
January 2015: Gaceta Sanitaria
Hsien-Yeang Seow, Lyn M Sibley
BACKGROUND: Health system planners aim to pursue the three goals of Triple Aim: 1) reduce health care costs; 2) improve population health; and 3) improve the care experience. Moreover, they also need measures that can reliably predict future health care needs in order to manage effectively the health system performance. Yet few measures exist to assess Triple Aim and predict future needs at a health system level. The purpose of this study is to explore the novel application of a case-mix adjustment method in order to measure and help improve the Triple Aim of health system performance...
2014: BMC Health Services Research
Chandra J Cohen, Natalie Flaks-Manov, Marcelo Low, Ran D Balicer, Efrat Shadmi
The current study aimed to develop a patient selection process for muiltimorbid care management that balances the needs to accurately identify patients who are at risk for future high costs and assures that those selected can clinically benefit from proactive care management. Six physicians were surveyed on characteristics of their current (2012) patients to elicit clinical considerations for high-risk patient identification. Data from 2010-2011 were extracted from Clalit Health Services' (Israel's largest managed care organization) comprehensive database to derive the Adjusted Clinical Groups (ACG) predictive model risk scores for risk of future high costs...
February 2015: Population Health Management
Edurne Alonso-Morán, Altynai Satylganova, Juan F Orueta, Roberto Nuño-Solinis
BACKGROUND: The aim of the study was to estimate the prevalence of depression in the population diagnosed with diabetes type 2 and to test the hypothesis that the presence of depression in such cases was associated with a) worse glycaemic control, and b) higher healthcare costs. METHODS: We conducted a cross-sectional analysis, from 1st September 2010 to 31st August 2011, among patients with type 2 diabetes aged 35 years and over in the Basque Country. It was identified how many of them had also depression...
2014: BMC Public Health
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