Publication: Tailoring integrated care services for high-risk patients with multiple chronic conditions: a risk stratification approach using cluster analysis
| dc.contributor.author | Bretos Azcona, Pablo Evaristo | |
| dc.contributor.author | Sánchez Iriso, Eduardo | |
| dc.contributor.author | Cabasés Hita, Juan Manuel | |
| dc.contributor.department | Economía | es_ES |
| dc.contributor.department | Ekonomia | eu |
| dc.contributor.funder | Gobierno de Navarra / Nafarroako Gobernua | es |
| dc.date.accessioned | 2021-02-02T09:41:05Z | |
| dc.date.available | 2021-02-02T09:41:05Z | |
| dc.date.issued | 2020 | |
| dc.description.abstract | Background: The purpose of this study was to produce a risk stratification within a population of high-risk patients with multiple chronic conditions who are currently treated under a case management program and to explore the existence of different risk subgroups. Different care strategies were then suggested for healthcare reform according to the characteristics of each subgroup. Methods: All high-risk multimorbid patients from a case management program in the Navarra region of Spain were included in the study (n = 885). A 1-year mortality risk score was estimated for each patient by logistic regression. The population was then divided into subgroups according to the patients' estimated risk scores. We used cluster analysis to produce the stratification with Ward's linkage hierarchical algorithm. The characteristics of the resulting subgroups were analyzed, and post hoc pairwise tests were performed. Results: Three distinct risk strata were found, containing 45, 38 and 17% of patients. Age increased from cluster to cluster, and functional status, clinical severity, nursing needs and nutritional values deteriorated. Patients in cluster 1 had lower renal deterioration values, and patients in cluster 3 had higher rates of pressure skin ulcers, higher rates of cerebrovascular disease and dementia, and lower prevalence rates of chronic obstructive pulmonary disease. Conclusions: This study demonstrates the existence of distinct subgroups within a population of high-risk patients with multiple chronic conditions. Current case management integrated care programs use a uniform treatment strategy for patients who have diverse needs. Alternative treatment strategies should be considered to fit the needs of each patient subgroup. | en |
| dc.description.sponsorship | Pablo E. Bretos-Azcona thanks the Government of Navarra for their financial support under the funding scheme 'Plan de Formación y de I+D 2018'. | en |
| dc.format.extent | 9 p. | |
| dc.format.mimetype | application/pdf | en |
| dc.identifier.doi | 10.1186/s12913-020-05668-7 | |
| dc.identifier.issn | 1472-6963 (Electronic) | |
| dc.identifier.uri | https://academica-e.unavarra.es/handle/2454/39117 | |
| dc.language.iso | eng | en |
| dc.publisher | BioMed Central | en |
| dc.relation.ispartof | BMC Health Services Research, 2020, 20, 806 | en |
| dc.relation.publisherversion | https://doi.org/10.1186/s12913-020-05668-7 | |
| dc.rights | © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. | en |
| dc.rights.accessRights | info:eu-repo/semantics/openAccess | |
| dc.rights.uri | http://creativecommons.org/licenses/by/4.0/ | |
| dc.subject | Risk stratification | en |
| dc.subject | Integrated care | en |
| dc.subject | Case management | en |
| dc.subject | Cluster analysis | en |
| dc.title | Tailoring integrated care services for high-risk patients with multiple chronic conditions: a risk stratification approach using cluster analysis | en |
| dc.type | info:eu-repo/semantics/article | |
| dc.type.version | info:eu-repo/semantics/publishedVersion | en |
| dc.type.version | Versión publicada / Argitaratu den bertsioa | es |
| dspace.entity.type | Publication | |
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