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The importance of comorbidity in analysing patient costs in Swedish primary care
Linköping University, Department of Medicine and Health Sciences. Linköping University, Faculty of Health Sciences.
The Neurotec Department, Center for Family and Community Medicine, Karolinska Institutet, Stockholm, Sweden.
Linköping University, Department of Medicine and Health Sciences. Linköping University, Faculty of Health Sciences.
The Neurotec Department, Center for Family and Community Medicine, Karolinska Institutet, Stockholm, Sweden.
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2006 (English)In: BMC Public Health, ISSN 1471-2458, Vol. 36, no 6, 36-42 p.Article in journal (Refereed) Published
Abstract [en]

Background

The objective was to explore the usefulness of the morbidity risk adjustment system Adjusted Clinical Groups® (ACG), in comparison with age and gender, in explaining and estimating patient costs on an individual level in Swedish primary health care. Data were retrieved from two primary health care centres in southeastern Sweden.

Methods

A cross-sectional observational study. Data from electronic patient registers from the two centres were retrieved for 2001 and 2002, and patients were grouped into ACGs, expressing the individual combination of diagnoses and thus the comorbidity. Costs per patient were calculated for both years in both centres. Cost data from one centre were used to create ACG weights. These weights were then applied to patients at the other centre. Correlations between individual patient costs, age, gender and ACG weights were studied. Multiple linear regression analyses were performed in order to explain and estimate patient costs.

Results

The variation in individual patient costs was substantial within age groups as well as within ACG weight groups. About 37.7% of the individual patient costs could be explained by ACG weights, and age and gender added about 0.8%. The individual patient costs in 2001 estimated 22.0% of patient costs in 2002, whereas ACG weights estimated 14.3%.

Conclusion

ACGs was an important factor in explaining and estimating individual patient costs in primary health care. Costs were explained to only a minor extent by age and gender. However, the usefulness of the ACG system appears to be sensitive to the accuracy of classification and coding of diagnoses by physicians.

Place, publisher, year, edition, pages
2006. Vol. 36, no 6, 36-42 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-13654DOI: 10.1186/1471-2458-6-36OAI: oai:DiVA.org:liu-13654DiVA: diva2:21116
Available from: 2009-02-22 Created: 2009-02-22 Last updated: 2009-03-10Bibliographically approved
In thesis
1. Quality, costs and the role of primary health care
Open this publication in new window or tab >>Quality, costs and the role of primary health care
2004 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The general aim of this thesis is to describe and analyse the role of primary care in health care systems in terms of health, health care utilisation and costs, and to study the feasibility of retrieval of data from computerised medical records to monitor medical quality.

The thesis includes five studies, a systematic literature review, a register study of utilisation of hospital and primary care, a study based on data from computerised medical records of individual patients cost for primary care, and two studies of management of respiratory infections in primary care based on data from computerised medical records of twelve health centres.

The general findings of the literature review were that an expansion of the primary care component of the health care system would most likely result in better health, lower hospital care consumption and lower expenses for care. The personal physician and continuity of care were core elements to achieve this, and the significance of the way primary care is organised and funded was evident.

In the register study fifty health centres were compared. Age and rates of outpatient hospital visits were the most important factors explaining the variation of rates of hospitalisations between the health centres’ areas. Hospital district also influenced hospitalisation rates in the different health centres’ areas, indicating that the health care structure in the district per se was an important factor. The rates of visits to general practitioners correlated negatively with rates of hospitalisations.

The study of costs in primary care showed that the variation in the costs of the individual patients was substantial, also within age groups and within the diagnosis-related Adjusted Clinical Groups (ACG). Age and gender explained a smaller part of the variation in costs per patient in primary care. Adding the ACG weight had a major influence on improving the ability to explain the variation in costs at patient level. The ACG system might be of value in the calculation of weighted capitation in Swedish primary care, but appears to be sensitive to the thoroughness with which physicians register diagnoses.

The retrieval of data from computerised medical records comprised a total number of 19 965 encounters for respiratory tract infections i.e. 199 per 1000 inhabitants during the year 2001. Most frequent diagnoses were common cold, acute tonsillitis, and acute bronchitis. The number of antibioticprescriptions was 7 961, accounting for 47% of the episodes. The most commonly prescribed antibiotics were phenoxymethylpenicillin (61%), tetracyclines (18%) and macrolides (8%).

A rapid test was performed in 43% of the encounters: for C-reactive protein (CRP) in 31%; for Group A beta-haemolytic streptococci (StrepA) in 22%; and both tests were performed in 10% of the encounters. The findings in the study indicate that StrepA and CRP tests were used too frequently and often with minor contributions to patient management. The frequencies of tests and of antibiotic prescriptions varied greatly between health centres in a way that hardly could be explained by differences in morbidity.

Computerised medical records provided a source of clinical information, which might be a feasible and pragmatic method for studying daily practice, and for follow-up of adherence to guidelines in general practice.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2004. 72 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 854
Keyword
Drug utilization review methods, Hospitalization statistics and numerical data, Outpatient clinics, hospital utilization, Primary health care, Quality of health care, Respiratory tract infections, drug therapy, Family practice, Cost-benefit analysis, Efficiency, Organizational, Health care costs
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-5198 (URN)91-7373-827-1 (ISBN)
Public defence
2004-06-03, Aulan, Hälsans hus, Campus US, Linköpings universitet, Linköping, 13:00 (English)
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Supervisors
Available from: 2004-06-23 Created: 2004-06-23 Last updated: 2012-01-25Bibliographically approved

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Engström, Sven GÖstgren, Carl-JohanBorgquist, Lars

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