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Embedding ACGs in Berkshire

NHS Berkshire Embedding ACGs in Berkshire Karen Grannum Primary Care Business Intelligence Lead

Using the ACG Toolkit to Support Population Monitoring

DST Health Solutions Using the ACG Toolkit to Support Population Monitoring Lisa Kabasakalian

Monday(C3)-Identifying Potentially Actionable Chronic Disease Patterns From Diagnoses Reported in Administrative Claims-Dave Bodycombe

Identifying Potentially Actionable Chronic Disease Patterns From Diagnoses Reported in Administrative Claims —Dave Bodycombe, Johns Hopkins University

Tuesday(C6)-Integration of claim-based diagnoses with diagnoses from General Practitioners (GPs) clinical database records improves the comorbidity description”-Corti

 Integration of claim-based diagnoses with diagnoses from General  Practitioners (GPs) clinical database records improves the comorbidity description” Maria Chiara Corti,  E. Schievano F. Avossa, K. Kinder, […]

What causes ’poly-morbidity’? Searching for triggers of multi-morbidity: tracing patient record 30 years back

Lennart Carlsson, PhD; Gunnar H Nilsson, Professor; Centre for Family Medicine, Karolinska Institutet, Sweden

Beyond Risk Scores: Lisa Kabasakalian, DST Health Solutions

ACG System DST Health Solutions Beyond Risk Scores: Identifying “High-Risk” and “At-Risk” Populations Lisa Kabasakalian

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The ACG System Worldwide

ACG System Executive Director Karen Kinder, PhD, provides a candid tour of the ACG System’s international history and evolution to what is now the most […]

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Population Segmentation Case Study – Government

Three Clinical Commissioning Groups (CCGs) analyzed their local populations as part of a new national initiative to address the care of people who are frail.  Learn more.

Incident atrial fibrillation in the emergency department in Ontario: a population-based retrospective cohort study of follow-up care

CMAJ Open 3:E182. Institute for Clinical Evaluative Sciences, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada BACKGROUND: Continuity of care has been shown to […]

Comprehensive preventive care assessments for adults with intellectual and developmental disabilities in Ontario – Part 2: 2003-2014

Objective To determine if there has been an increase in preventive care among adults with IDD as a result of the publication of the Canadian […]

Association between method of pelvic organ prolapse repair involving the vaginal apex and re-operation: a population-based, retrospective cohort study

Abstract Introduction and hypothesis Vaginal apical suspension is essential for the surgical treatment of pelvic organ prolapse (POP). We aim to evaluate whether the method […]

Patient-reported symptoms following mastectomy alone or lumpectomy plus radiation for early stage breast cancer: a cohort study

Abstract Purpose Studies examining symptom differences between surgeries for breast cancer patients rarely incorporate the effects of adjuvant treatment choice. We sought to understand differences […]

Rapid repeat pregnancy among women with intellectual and developmental disabilities: a population-based cohort study

Abstract   BACKGROUND Rapid repeat pregnancy within 12 months of a live birth is associated with adverse perinatal outcomes. We evaluated the risk for rapid […]

Comparing Survey-Based Frailty Assessment to Medicare Claims in Predicting Health Outcomes and Utilization in Medicare Beneficiaries

Abstract   Objectives To assess two models for the prediction of health utilization and functions using standardized in-person assessments of frailty and administrative claims-based geriatric […]

Association of Care Management Intensity With Healthcare Utilization in an All-Condition Care Management Program

ABSTRACT Objectives: To identify care needs among Medicaid and Medicare patients in an all-condition care management program involving case managers (CMs) and community health workers (CHWs), […]

One-Year Mortality After Emergency Department Visit for Nonfatal Opioid Poisoning: A Population-Based Analysis

Abstract Study objective We aim to characterize the incidence and risk factors for opioid-related and all-cause mortality in the year after an emergency department (ED) […]

Colonoscopy resource availability and its association with the colorectal cancer diagnostic interval: A population‐based cross‐sectional study

Abstract Background Colonoscopy is a key resource used to diagnose colorectal cancer (CRC). This study evaluated the relationship between colonoscopy availability and the length of […]

Variation in care of patients with elderly-onset inflammatory bowel disease in Ontario, Canada: A population-based cohort study

Abstract Background Variation in health care, when not based on patient preference, may result in poorer care. We determined whether variation in health services utilization, […]

Mental Health Services Provision in Primary Care and Emergency Department Settings: Analysis of Blended Fee-for-Service and Blended Capitation Models in Ontario, Canada

Abstract Treating mental illnesses in primary care is increasingly emphasized to improve access to mental health services. Although family physicians (FPs) or general practitioners are […]

Impact of Frailty on Clinical Outcomes after Carotid Artery Revascularization

Abstract Objectives : Frailty has been increasingly recognized as an important risk factor for vascular procedures. To assess the impact of frailty on clinical outcomes and […]

Health Status of Females Who Experience Incarceration: A Population-Based Retrospective Cohort Study

Abstract Background People who experience incarceration have poor health across a variety of indicators, but we lack population-level data on the health of females in […]

Concurrent hiatal hernia repair and bariatric surgery: outcomes after sleeve gastrectomy and Roux-en-Y gastric bypass

Abstract Background Hiatal hernias are often repaired concurrently with bariatric surgery to reduce risk of gastroesophageal reflux disease–related complications. Objectives To examine the association between […]

Explanatory Ability of the ACG System Regarding the Utilization and Expenditure of the National Health Insurance Population in Taiwan—A 5-year Analysis

ABSTRACT Background The adjusted clinical group (ACG) is a diagnosis-based case-mix adjustment system, which has been widely evaluated in several countries other than Taiwan. The […]

Impact of Frailty on Clinical and Financial Outcomes Following Minor Lower Extremity Amputation: A Nationwide Analysis

Abstract Objective Frailty has been shown to portend worse outcomes in surgical patients. Our goal was to identify the impact of frailty on outcomes and […]

Predicting Future Health Risk in COPD: Differential Impact of Disease-Specific and Multi-Morbidity-Based Risk Stratification

Abstract Objective Multi-morbidity contributes to mortality and hospitalisation in COPD, but it is uncertain how this interacts with disease severity in risk prediction. We compared […]

A Population-Based Analysis of Long-Term Outcomes Among Older Adults Requiring Unexpected Intensive Care Unit Admission After Cancer Surgery

Abstract Background High-intensity cancer surgery is increasingly common among older adults. However, these patients are at high-risk for unexpected intensive care unit (ICU) admissions after […]

Pain and haemorrhage are the most common reasons for emergency department use and hospital admission in adults following ambulatory surgery: results of a population-based cohort study

Abstract Background Advances in healthcare delivery have allowed for the increase in the number of ambulatory surgery procedures performed in Canada. Despite these advances, patients […]

Intensive Use of Forensic Inpatient Services by People with Intellectual and Developmental Disabilities in Ontario, Canada: Prevalence and Associated Characteristics

Abstract Background People with intellectual/developmental disabilities (IDD) are reportedly intensive users of forensic inpatient services. Methods Using administrative data, we identified people with and without […]

Outcomes of SARS-CoV-2 infection in cancer versus non-cancer-patients: A population-based study in northeastern Italy

Abstract Introduction This study assesses the risk of infection and clinical outcomes in a large consecutive population of cancer and non-cancer patients tested for SARS-CoV-2 […]

The impact of frailty on adjuvant treatment in patients with head and neck free flap reconstruction—A retrospective study using two independent frailty scores

Abstract Objectives Reconstructive surgery may result in prolonged postoperative recovery, especially in frail patients, which in turn may impact delivery of adjuvant therapy. To date, […]

Health Care Utilization among Adult Survivors of Childhood and Adolescent Cancer in Ontario

Abstract Survivors of childhood and adolescent cancers are at increased risk for late effects including subsequent cancer, cardiotoxicities, and poor psychosocial health. Few studies have […]

Differences in health care costs between two social health support programs: findings from a randomized social health integration pilot program

Abstract Introduction More health systems are implementing strategies to understand and address patient social health, also known as social health integration. We examine the impact […]

Incidence of Respiratory Syncytial Virus-Associated Hospitalization Among Adults in Ontario, Canada, 2017–2019

Abstract Background Respiratory syncytial virus (RSV) causes substantial morbidity and mortality among adults. Given recent RSV vaccine authorizations, data on groups at highest risk are […]

Healthcare utilization patterns and costs related to neurofibromatosis 1 in Ontario, Canada

Abstract Background and objectives Neurofibromatosis type 1 (NF1) is a multisystemic disease, characterized by cutaneous manifestations and peripheral nerve sheath tumors. Patients also have a […]

The effect of frailty on early postoperative outcomes of lobectomy for lung cancer in older adults – A United States National Retrospective Cohort Study

Abstract Introduction Pulmonary lobectomy represents the primary curative treatment for lung cancer in older adults, yet frailty’s impact on critical early postoperative outcomes remains inadequately […]

Comorbidities and Healthcare Utilization in 4197 Patients With Prurigo Nodularis in Israel: A Cross-Sectional Population-Based Analysis

ABSTRACT Background Prurigo nodularis patients face a significant burden of comorbidities, necessitating a comprehensive approach to care. We aimed to explore the association between prurigo […]

Improving models to predict care utilization using machine learning: a retrospective observational study

Abstract Background: Use of artificial intelligence (AI) and machine learning (ML) tools is now common in the advancement of healthcare services and clinical risk estimation. Legacy […]

External validation and head-to-head comparison of Eclipse-PRISM and Johns Hopkins ACG risk scores for predicting emergency admissions in an English older population

ABSTRACT Background Predictive risk stratification tools are widely used to support proactive care for older adults, yet head-to-head external validation within local English health systems […]

Return on investment from primary care price reductions in a consumer choice health plan design

Abstract Background There is growing interest among insurers and policy makers in the United States in primary care playing an expanded role to improve quality […]

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ACG System White Paper

 THE JOHNS HOPKINS ACG® SYSTEM is a leading risk measurement methodology that was developed and continues to be tested and improved at the Bloomberg School […]

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Risk Stratification: Identifying Geriatric Frailty from EHR Unstructured Data

With providers engaging more with risk stratification tools, unstructured data and free text from Electronic Health Records (EHRs), a potential exists to more effectively identify […]

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Care Density: A Social Network Approach to Claims Data

If optimizing quality of care, clinical outcomes and cost effectiveness is one of your priorities, ensuring your patient population receives comprehensive, coordinated care from their […]

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Understanding Population Health

With the challenges facing our health and social care services and the need to develop new care models to achieve the triple aim of improving […]

Risk aversion and costs: a comparison of family physicians and general internists

J Fam Pract 49:12-17. Department of Family Medicine, University of Rochester, New York, NY, USA No abstract Comment in: Interspeciality differences in medical resource utilization. […]

Obstructive sleep apnea and incident diabetes

A historical cohort study. Am J Respir Crit Care Med 190:218-225. University of Toronto, Toronto, ON, Canada; Institute for Clinical Evaluative Sciences, Toronto, ON, Canada; […]

The pattern of urologic care among traumatic spinal cord injured patients

Can Urol Assoc J 8:E805. Institute for Clinical Evaluative Sciences, Toronto, ON, Canada INTRODUCTION: We assessed the urologic care patterns of traumatic spinal cord injury […]

Risk factors for reoperation and mortality after the operative treatment of tibial plateau fractures in Ontario, 1996-2009

J Orthop Trauma 29:182-188. University of Toronto, Toronto, ON, Canada; Institute for Clinical Evaluative Sciences, Toronto, ON, Canada OBJECTIVE: To define the rates and risk […]

Do different case-mix measures affect assessments of provider efficiency? Lessons from the Department of Veterans Affairs

J Ambul Care Manage 26:229-242. Center for Health Quality, Outcomes and Economic Research, Bedford VAMC, Bedford, MA, USA Although case-mix adjustment is critical for provider […]

Achieving weight loss and hypertension control among obese adults: a US multidisciplinary group practice observational study

Am J Hypertens University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Veterans Affairs Pittsburgh Healthcare System , Pittsburgh, PA, USA; University […]

Association between the patient-centered medical home and healthcare utilization

Am J Manag Care 21:378-386. Weill Cornell Medical College, New York, NY, USA OBJECTIVES: The patient-centered medical home (PCMH) model of primary care is being […]

Caring for dementia: a population-based study examining variations in guideline-consistent medical care

Alzheimers Dement 11:906-916. UBC Centre for Health Services and Policy Research, School of Population and Public Health, Vancouver, BC, Canada BACKGROUND: Evidence indicates that early […]

What do we mean by multimorbidity? An analysis of the literature on multimorbidity measures, associated factors, and impact on health services organization

Rev Epidemiol Sante Publique 62:305-314. Hôpital Jean-Verdier, Bondy, France; Université Paris, Paris Cité, Bobigny, France BACKGROUND: Multimorbidity is a consequence of both epidemiological and demographic […]

The development of a risk-adjusted capitation payment system: the Maryland Medicaid model

J Ambul Care Manage 21:29-52. School of Public Health, Johns Hopkins University, Baltimore, MD, USA This article describes the risk-adjusted payment methodology employed by the […]

Does high-risk pool coverage meet the needs of people at risk for disability?

Inquiry 45:340-352. University of Kansas, Lawrence, KS, USA State high-risk insurance pools serve people denied coverage because of pre-existing conditions. With benefit plans modeled on […]

Comparison of Rx-defined morbidity groups and diagnosis-based risk adjusters for predicting healthcare costs in Taiwan

BMC Health Serv Res 10:126./p> Institute of Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan BACKGROUND: Medication claims are commonly used to […]

Classification systems in case-mix groups in ambulatory care. Perspectives for our primary health care

Aten Primaria 17:76-82. Published in Spanish. Unitat d’Investigació Centre, Institut Català de la Salut, CESCA, Barcelona, Spain No abstract PMID: 8742149

Proton-pump inhibitor use is not associated with osteoporosis or accelerated bone mineral density loss

Gastroenterology 138:896-904. Section of Gastroenterology, Division of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada BACKGROUNDS and AIMS: Recent studies have shown an association between […]

Primary care and specialty care for US children: what is the right mix?

Arch Pediatr Adolesc Med 157:219-220. Institute for Health Policy, MassGeneral Hospital for Children, Boston, MA, USA THE VERY TITLE of the article by Forrest et […]

Evaluation of the equity of age-sex adjusted primary care capitation payments in Ontario, Canada

Health Policy 104:186-192. Institute for Clinical Evaluative Sciences, Sunnybrook Health Sciences Centre, Toronto, ON, Canada OBJECTIVE: Several innovative primary care models have recently been introduced […]

Ambulatory care provided by office-based specialists in the United States

Ann Fam Med 7:104-111. National Primary Care Research and Development Centre, University of Manchester, Manchester, UK PURPOSE: Increasing use of specialist services in the United […]

Adjust utilization for case mix and make physicians responsible for remaining variation

Data Strateg Benchmarks 2:25-28. “But my patients are sicker!” Health Source/CIGNA put a stop to this physician complaint by switching to quarterly physician profiles that […]

Comparing the medical expenses of adults with Medicaid and commercial insurance in a health maintenance organization

J Health Care Poor Underserved 14:420-435. Division of Research, Kaiser Permanente Medical Care Program, Northern California Region, Oakland, CA, USA The objective of this study […]

Risk adjustment of mental health and substance abuse payments

Inquiry 35:223-239. Department of Health Care Policy, Harvard Medical School, Boston, MA, USA This study used 1992 and 1993 data from private employers to compare […]

The importance of the data quality in the validation of the ACG case mix

Ambulatory Care Groups. Aten Primaria 22:128. Published in Spanish. Osakidetza Servicio Vasco de Salud, Bizkaia, Spain No abstract Comment on:[A retrospective evaluation of the behaviour […]

Promoting advance directives among elderly primary care patients

J Gen Intern Med 19:944-951. Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA OBJECTIVE: To determine efficient ways of promoting advance directives among […]

Licit prescription drug use in a Swedish population according to age, gender and socioeconomic status after adjusting for level of multi-morbidity

BMC Public Health 12:575. Blekinge Centre of Competence, Karlskrona, Sweden BACKGROUND: There is a great variability in licit prescription drug use in the population and […]

A method for estimating cost savings for population health management programs

Health Serv Res 48:582-602. Research and Development, Johns Hopkins HealthCare LLC, Glen Burnie, MD, USA OBJECTIVE: To develop a quasi-experimental method for estimating Population Health […]

The prospective risk adjustment system

J Ambul Care Manage 22:41-52. 3M Health Information Systems, Wallingford, CT, USA The Episode Classification System is intended to perform two tasks. First, it will […]

Effects of comorbidity and clustering upon referrals in primary care

J Am Board Fam Pract 18:449-452. Department of Family Medicine, University of Washington, Seattle, WA, USA OBJECTIVE: To examine the effect of patient characteristics and […]

A pilot test of the effect of guided care on the quality of primary care experiences for multimorbid older adults

J Gen Intern Med 23:536-542. Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA OBJECTIVE: Improving […]

Increasing value for money in the Canadian healthcare system: new findings on the contribution of primary care services

Healthc Q 12:32-44. Hollander Analytical Services Ltd., Victoria, BC, Canada This article presents a major new finding in regard to the value for money of […]

The economic value of a wellness and disease prevention program

Popul Health Manag 13:309-317. HealthMedia, Inc., Ann Arbor, MI, USA The objective of this study was to determine the economic impact of the Hawaii Medical […]

Employment of mid-level providers in primary care and control of diabetes

Prim Care Diabetes 5:25-31. Center for Health Services Research in Primary Care, Veterans Affairs Medical Center, Durham, NC, USA AIMS: Examine potential associations between inclusion […]

High-deductible insurance: two-year emergency department and hospital use

Am J Manag Care 17:e410-8. Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA OBJECTIVES: To determine the […]

Evaluating patient adherence to antidepressant therapy among uninsured working adults diagnosed with major depression: results of the Texas Demonstration to Maintain Independence and Employment study

Adm Policy Ment Health 39:374-382. Addiction Research Institute, University of Texas at Austin, Austin, TX, USA This study examined antidepressant adherence and persistence among uninsured […]

Factors associated with 90-day death after emergency department discharge for atrial fibrillation

Ann Emerg Med 61:539-548.e1. Institute for Clinical Evaluative Sciences, Toronto, ON, Canada STUDY OBJECTIVE: More than 10% of patients treated in the emergency department (ED) […]

Physician assistants and nurse practitioners perform effective roles on teams caring for Medicare patients with diabetes

Health Aff 32:1942-1948. University of Wisconsin–Madison, WI, USA; University of Pittsburgh School of Pharmacy, Pittsburgh, PA, USA One approach to the patient-centered medical home, particularly […]

The influence of socio-economic status and multimorbidity patterns on healthcare costs: a six-year follow-up under a universal healthcare system

Int J Equity Health 12:69. Center of Comparative Effectiveness Research, National Center of Excellence for Clinical Trial and Research, National Taiwan University Hospital, Taipei City, […]

Spreading a medical home redesign: effects on emergency department use and hospital admissions

Ann Fam Med 11 Suppl 1:S19-S26. Group Health Physicians, Seattle, WA, USA PURPOSE: The patient-centered medical home (PCMH) is being rapidly deployed in many settings […]

High use of health services in patients with suboptimal asthma drug regimens: a population-based assessment in British Columbia, Canada

Pharmacoepidemiol Drug Saf 22:744-751. University of British Columbia, Vancouver, BC, Canada; BC Children’s Hospital, Vancouver, BC, Canada; Child and Family Research Institute, Vancouver, BC, Canada; […]

Impact of poorly controlled hypertension on healthcare resource utilization and cost

Am J Manag Care 7:389-398. MEDTAP International, Bethesda, MD, USA OBJECTIVE: To examine the relation between blood pressure (BP) control and utilization and cost of […]

Comparison of comorbidity classification methods for predicting outcomes in a population-based cohort of adults with human immunodeficiency virus infection

Ann Epidemiol 24:532-537. St. Michael’s Hospital, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada; Institute for Clinical Evaluative Sciences, Toronto, ON, Canada PURPOSE: We […]

Development of a predictive risk model for unplanned admissions in the Basque Country

Rev Esp Salud Publica 88:251-260. Published in Spanish. Centro de Salud de Astrabudua,.Osakidetza (Servicio Vasco de Salud), Erandio. Bizkaia, Spain; Instituto Vasco de Innovación Sanitaria. […]

Do some physician groups see sicker patients than others? Implications for primary care policy in Manitoba

Winnipeg, MB, Canada: Manitoba Centre for Health Policy. Manitoba Centre for Health Policy, Winnipeg, MB, Canada Canadian policy makers are considering a variety of new […]

Ontario MedsCheck annual pharmacy medication review service: a comparison between initial and well established implementation periods

International Conference for Pharmacoepidemiology (ICPE) – August, 2015 Boston, MA, USA. Background: A MedsCheck Annual (MCA) consultation is a government-funded, medication review service in Ontario, […]

Risks of hospitalizations and surgery in elderly-onset inflammatory bowel disease: a population based study

Gastroenterology 146:S-171. Background: The incidence of Crohn’s disease (CD) and ulcerative colitis (UC) in the elderly population is reported to be increasing. Comorbid diseases, which […]

Patient based patterns of morbidity, a 17 year follow-up on patient records in primary care in Sweden

BMC Health Serv Res 7:A13. Karolinska Institute, Stockholm, Sweden BACKGROUND: Longitudinal studies on clinical categories of patients in primary health care are rare, as are […]

Development and evaluation of the Johns Hopkins University risk adjustment models for Medicare+Choice plan payment

Final report to Centers for Medicare and Medicaid Services, US Department of Health and Human Services. Baltimore, MD, USA: Johns Hopkins University. Johns Hopkins University, […]

Characteristics of Maryland residents who obtain health insurance from the small and large group markets

Bethesda, MD, USA: Project Hope Center for Health Affairs. Project Hope, Bethesda, MD, USA This report contains findings from a project conducted by the Project […]

Developing re-insurance and carve-out risk adjusters for an under 65 population

Johns Hopkins University, Lewin Group. Prepared for Health Care Financing Administration. Fairfax, VA, USA: Lewin Group. Johns Hopkins University, Baltimore, MD, USA; Lewin Group, Fairfax, […]

The ambulatory case-mix development project

Project final report. Baltimore, MD, USA: Johns Hopkins University and Aetna Health Plans. Johns Hopkins University and Aetna Health Plans, USA As the US health […]

Analysis of Medicaid payments for American Indians and Alaska Natives

Baltimore, MD, USA: CMS Tribal Affairs Group.. CMS Tribal Affairs Group, Baltimore, MD, USA The Indian Health Service (IHS) is a discretionary federal program that […]

Quality, costs and the role of primary health care

Linkoping, Sweden: Linkoping University. Linkoping University, Linkoping, Sweden The general aim of this thesis is to describe and analyse the role of primary  care in […]

Adherence to prescription drugs and adverse health events for patients with hypertension

Los Angeles, CA, USA: University of California, Los Angeles (doctoral dissertation). University of California, Los Angeles, CA, USA Increased technology in the development of effective […]

Time to readmission among chronically ill community-resident beneficiaries: variations by geographic area and provider type

Baltimore, MD, USA: Centers for Medicare and Medicaid Services. Schneider Institute for Health Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, MA, […]

Optimal primary care for elders: periodic health examination and interdisciplinary geriatric team care

Waltham, MA, USA: Brandeis University (doctoral dissertation). Brandeis University, Waltham, MA, USA Health care organizations must find creative ways to achieve cost-efficient, high-quality primary care […]

Ischemic heart disease (IHD) and related health care utilization in Metis in Manitoba

Winnipeg, MB, Canada: Manitoba Metis Federation. Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada; Health & Wellness Department, Manitoba Metis Federation, Winnipeg, […]

Evaluation of the implementation of advanced nursing competencies in the Basque health care system

J Nurs Ed Pract 3:23-29. Basque Institute for Healthcare Innovation, Sondika, Bizkaia, Spain In 2011 advanced competences in nursing were defined and pilot tested in […]

Developing new comorbidity indices for cancer populations using administrative data

Dunedin, New Zealand: University of Otago (doctoral dissertation). University of Otago, Dunedin, New Zealand BACKGROUND: Comorbidity has an important impact on cancer outcomes, but the […]