The role of the clinical risk group classification system in the management of oncologic patients in need of high complexity of care. A pilot study in the local health unit “USL Umbria 2”

Abstract

Background: Complex oncologic patients require high standards of care, multidisciplinary approach and great resources. The aim of our study is to evaluate the capability of the 3M Clinical Risk Group (3M CRG) system in identifying and managing this specific type of population. Patients and methods: The study was conducted on a cohort of oncologic patients in need of highly complex care provided by six districts in the Umbria 2 Local Health Unit (USL) during 2013. This cohort of patients was identified through the 3M Clinical Risk Grouping Software by using individual demographic, morbidity and pharmaceutical information retrieved from administrative data (e.g. inpatient, outpatient, drug). The same system (CRG) stratified the population from nine mutually exclusive health status up to 1080 risk groups. Both the analysis of the healthcare provided and the analysis of costs entailed were computed in all the six districts. Results: In 2013, USL Umbria 2 provided health care to 2682 patients (0.7% of the total population; 11% of the total health care expenditure) assigned by 3M CRG to the health status 8 (dominant and metastatic malignancies) and 5 severity of illness. The patients were predominantly males (51.52%) and belonging to 55-74 years age group (47.76%). 97.95% of the cohort was hospitalized. In all the six districts, the largest amount of resources was provided for inpatient care. Terni district had the largest number of patients with health status 8 (33.89%). Orvieto district recorded the highest healthcare cost (€17978.7). Conclusions: Our study confirmed CRG as a useful system to identify different high-need population and manage complex oncologic patients by assessing their needs and adjusting interventions and resources. The CRG system combines inpatient data with information from territorial services. For this reason it can be a useful tool for epidemiological analysis, governance of therapeutic-diagnostic pathways and continuity of healthcare in sync with “Italian plan of the chronicity”.