papers

Comparison of three methods for measuring multiple morbidity according to the use of health resources in primary healthcare

Aten Primaria 44:348-357. Published in Spanish.

Badalona Serveis Assistencials, Badalona, Barcelona, Spain

OBJECTIVE: To compare three methods of measuring multiple morbidity according to the use of health resources (cost of care) in primary healthcare (PHC).

DESIGN: Retrospective study using computerized medical records.

SETTING: Thirteen PHC teams in Catalonia (Spain).

PARTICIPANTS: Assigned patients requiring care in 2008.

MAIN MEASUREMENTS: The 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 (R(2)), p< .05.

RESULTS: The study included 227,235 patients. The mean unit of cost was €654.2. The CCI explained an R(2)=50.4%, the ChI an R(2)=29.2% and BUR an R(2)=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.

CONCLUSIONS: The 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.

PMID: 22014855