Comparación entre tres métodos de medida de la multimorbilidad en función del uso de recursos sanitarios en atención primaria

Abstract

ObjectiveTo compare three methods of measuring multiple morbidity according to the use of health resources (cost of care) in primary healthcare (PHC). DesignRetrospective study using computerized medical records. SettingThirteen PHC teams in Catalonia (Spain). ParticipantsAssigned patients requiring care in 2008. Main measurementsThe socio-demographic variables were co-morbidity and costs. Methods of comparison were: a) Combined Comorbidity Index (CCI): an index itself was developed from the scores of acute and chronic episodes, b) Charlson Index (ChI), and c) Adjusted Clinical Groups case-mix: resource use bands (RUB). The cost model was constructed by differentiating between fixed (operational) and variable costs. Statistical analysis: 3 multiple lineal regression models were developed to assess the explanatory power of each measurement of co-morbidity which were compared from the determination coefficient (R2), p< .05. ResultsThe study included 227,235 patients. The mean unit of cost was €654.2. The CCI explained an R2=50.4%, the ChI an R2=29.2% and BUR an R2=39.7% of the variability of the cost. The behaviour of the ICC is acceptable, albeit with low scores (1 to 3 points), showing inconclusive results. ConclusionsThe CCI may be a simple method of predicting PHC costs in routine clinical practice. If confirmed, these results will allow improvements in the comparison of the case-mix.