Abstract
In-hospital care of chronic patients is based on their characteristics and risk levels. Adjusted morbidity groups (AMG) is a population stratification tool which is currently being used in Primary Care but not in Hospitals. The objectives of this study were to describe the use of hospital services by chronic patients according to their risk levels assigned by AMG and to analyze influencing variables. In this cross-sectional study, patients aged ≥18 years from a healthcare service area classified as chronically ill by the AMG classification system who used their referral hospital services from June 2015 to June 2016 were included. Predisposing and needs factors were collected. Univariate, bivariate and multiple linear regressions were performed. Of the 9,443 chronic patients identified (52.1% of the population in the selected area), 4,143 (43.9%) used hospital care services. Their mean age was 62.1 years (standard deviation (SD) = 18.4); 61.8% were female; 9% were high risk; 30% were medium risk, and 61% were low risk. The mean number of hospital service contacts was 5.0 (SD = 6.2), with 3.8 (SD = 4.3) visits to outpatient clinic, 0.7 (SD = 1.2) visits to emergency departments, 0.3 (SD = 2.8) visits to day hospital, and 0.2 (SD = 0.5) hospitalizations. The factors associated with greater service use were predisposing factors such as age (coefficient B (CB) = 0.03; 95% confidence interval (CI) = 0.01-0.05) and Spanish origin (CB = 3.9; 95% CI = 3.2-4.6). Among the needs factors were palliative care (CB = 4.8; 95% CI = 2.8-6.7), primary caregiver status (CB = 2.3; 95% CI = 0.7-3.9), a high risk level (CB = 2.9; 95% CI = 2.1-3.6), multimorbidity (CB = 0.8, 95% CI = 0.4-1.3), chronic obstructive pulmonary disease (COPD) (CB = 1.5, 95% CI = 0.8-2.3), depression (CB = 0.8, 95% CI = 0.3-1.3), active cancer (CB = 4.4, 95% CI = 3.7-5.1), and polymedication (CB = 1.1, 95% CI = 0.5-1.7). The use of hospital services by chronic patients was high and increased with the risk level assigned by the AMG. The most frequent type of contact was outpatient consultation. Use was increased with predisposing factors such as age and geographic origin and by needs factors such as multimorbidity, risk level and severe diseases requiring follow-up, home care, and palliative care.
Highlights
The progressively aging population [1, 2] and the increased prevalence of chronic diseases [3, 4] pose new challenges at the management level due to greater multimorbidity, functional impairment, and worse quality of life and lead to greater consumption of healthcare services, among other things [5, 6].Spain’s National Strategy for Addressing Chronicity [7] proposes using stratification models based on the Kaiser pyramid, which classifies chronic patients according to risk [8, 9]
The factors associated with greater service use were predisposing factors such as age (coefficient B (CB) = 0.03; 95% confidence interval (CI) = 0.01–0.05) and Spanish origin (CB = 3.9; 95% CI = 3.2–4.6)
The use of hospital services by chronic patients was high and increased with the risk level assigned by the Adjusted Morbidity Groups (AMG)
Summary
The progressively aging population [1, 2] and the increased prevalence of chronic diseases [3, 4] pose new challenges at the management level due to greater multimorbidity, functional impairment, and worse quality of life and lead to greater consumption of healthcare services, among other things [5, 6].Spain’s National Strategy for Addressing Chronicity [7] proposes using stratification models based on the Kaiser pyramid, which classifies chronic patients according to risk [8, 9]. Different predictive models are available for resource consumption groups according to the complexity of their morbidities without incorporating other dimensions, such as socioeconomic status, disability, frailty, care, clinical parameters, or assessment scales [11] They have replaced systems based exclusively on demographic data. Within these grouping models are Adjusted Clinical Groups (ACG) [12,13,14,15], Diagnostic Cost Groups (DCG-HCC) [12, 16], Community Assessment Risk (CRG) [12, 17], and Community Assessment Risk Screening (CARS) [18, 19] These tools for grouping population morbidity have been integrated into the electronic health records (EHRs) of health systems to estimate the health resources consumed by each person and stratify patients into different levels of risk to determine the type of management and intervention required. The objectives of this study were to describe the use of hospital services by chronic patients according to their risk levels assigned by AMG and to analyze influencing variables
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