Validating the Johns Hopkins ACG Case-Mix System of the elderly in Swedish primary health care

Anders Halling, Gerd Fridh, Ingvar Ovhed

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Resumé

Udgivelsesdato: 2006-null
OriginalsprogEngelsk
TidsskriftBMC Public Health
Vol/bind6
Sider (fra-til)171
ISSN1471-2458
DOI
StatusUdgivet - 1. jan. 2006
Udgivet eksterntJa

Fingeraftryk

Primary Health Care
Prescriptions
Comorbidity
Health Status Indicators
Sex Education
Proxy
Population
Health Services
Area Under Curve
Delivery of Health Care
Education
Health

Citer dette

Halling, Anders ; Fridh, Gerd ; Ovhed, Ingvar. / Validating the Johns Hopkins ACG Case-Mix System of the elderly in Swedish primary health care. I: BMC Public Health. 2006 ; Bind 6. s. 171.
@article{4f1b8c4051ff11df937d000ea68e967b,
title = "Validating the Johns Hopkins ACG Case-Mix System of the elderly in Swedish primary health care",
abstract = "BACKGROUND: Individualbased measures for comorbidity are of increasing importance for planning and funding health care services. No measurement for individualbased healthcare costs exist in Sweden. The aim of this study was to validate the Johns Hopkins ACG Case-Mix System's predictive value of polypharmacy (regular use of 4 or more prescription medicines) used as a proxy for health care costs in an elderly population and to study if the prediction could be improved by adding variables from a population based study i.e. level of education, functional status indicators and health perception. METHODS: The Johns Hopkins ACG Case-Mix System was applied to primary health care diagnoses of 1402 participants (60-96 years) in a cross-sectional community based study in Karlskrona, Sweden (the Swedish National study on Ageing and Care) during a period of two years before they took part in the study. The predictive value of the Johns Hopkins ACG Case-Mix System was modeled against the regular use of 4 or more prescription medicines, also using age, sex, level of education, instrumental activity of daily living- and measures of health perception as covariates. RESULTS: In an exploratory biplot analysis the Johns Hopkins ACG Case-Mix System, was shown to explain a large part of the variance for regular use of 4 or more prescription medicines. The sensitivity of the prediction was 31.9{\%}, whereas the specificity was 88.5{\%}, when the Johns Hopkins ACG Case-Mix System was adjusted for age. By adding covariates to the model the sensitivity was increased to 46.3{\%}, with a specificity of 90.1{\%}. This increased the number of correctly classified by 5.6{\%} and the area under the curve by 11.1{\%}. CONCLUSION: The Johns Hopkins ACG Case-Mix System is an important factor in measuring comorbidity, however it does not reflect an individual's capability to function despite a disease burden, which has importance for prediction of comorbidity. In this study we have shown that information on such factors, which can be obtained from short questionnaires increases the probability to correctly predict an individual's use of resources, such as medications.",
author = "Anders Halling and Gerd Fridh and Ingvar Ovhed",
year = "2006",
month = "1",
day = "1",
doi = "10.1186/1471-2458-6-171",
language = "English",
volume = "6",
pages = "171",
journal = "B M C Public Health",
issn = "1471-2458",
publisher = "BioMed Central",

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Validating the Johns Hopkins ACG Case-Mix System of the elderly in Swedish primary health care. / Halling, Anders; Fridh, Gerd; Ovhed, Ingvar.

I: BMC Public Health, Bind 6, 01.01.2006, s. 171.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - Validating the Johns Hopkins ACG Case-Mix System of the elderly in Swedish primary health care

AU - Halling, Anders

AU - Fridh, Gerd

AU - Ovhed, Ingvar

PY - 2006/1/1

Y1 - 2006/1/1

N2 - BACKGROUND: Individualbased measures for comorbidity are of increasing importance for planning and funding health care services. No measurement for individualbased healthcare costs exist in Sweden. The aim of this study was to validate the Johns Hopkins ACG Case-Mix System's predictive value of polypharmacy (regular use of 4 or more prescription medicines) used as a proxy for health care costs in an elderly population and to study if the prediction could be improved by adding variables from a population based study i.e. level of education, functional status indicators and health perception. METHODS: The Johns Hopkins ACG Case-Mix System was applied to primary health care diagnoses of 1402 participants (60-96 years) in a cross-sectional community based study in Karlskrona, Sweden (the Swedish National study on Ageing and Care) during a period of two years before they took part in the study. The predictive value of the Johns Hopkins ACG Case-Mix System was modeled against the regular use of 4 or more prescription medicines, also using age, sex, level of education, instrumental activity of daily living- and measures of health perception as covariates. RESULTS: In an exploratory biplot analysis the Johns Hopkins ACG Case-Mix System, was shown to explain a large part of the variance for regular use of 4 or more prescription medicines. The sensitivity of the prediction was 31.9%, whereas the specificity was 88.5%, when the Johns Hopkins ACG Case-Mix System was adjusted for age. By adding covariates to the model the sensitivity was increased to 46.3%, with a specificity of 90.1%. This increased the number of correctly classified by 5.6% and the area under the curve by 11.1%. CONCLUSION: The Johns Hopkins ACG Case-Mix System is an important factor in measuring comorbidity, however it does not reflect an individual's capability to function despite a disease burden, which has importance for prediction of comorbidity. In this study we have shown that information on such factors, which can be obtained from short questionnaires increases the probability to correctly predict an individual's use of resources, such as medications.

AB - BACKGROUND: Individualbased measures for comorbidity are of increasing importance for planning and funding health care services. No measurement for individualbased healthcare costs exist in Sweden. The aim of this study was to validate the Johns Hopkins ACG Case-Mix System's predictive value of polypharmacy (regular use of 4 or more prescription medicines) used as a proxy for health care costs in an elderly population and to study if the prediction could be improved by adding variables from a population based study i.e. level of education, functional status indicators and health perception. METHODS: The Johns Hopkins ACG Case-Mix System was applied to primary health care diagnoses of 1402 participants (60-96 years) in a cross-sectional community based study in Karlskrona, Sweden (the Swedish National study on Ageing and Care) during a period of two years before they took part in the study. The predictive value of the Johns Hopkins ACG Case-Mix System was modeled against the regular use of 4 or more prescription medicines, also using age, sex, level of education, instrumental activity of daily living- and measures of health perception as covariates. RESULTS: In an exploratory biplot analysis the Johns Hopkins ACG Case-Mix System, was shown to explain a large part of the variance for regular use of 4 or more prescription medicines. The sensitivity of the prediction was 31.9%, whereas the specificity was 88.5%, when the Johns Hopkins ACG Case-Mix System was adjusted for age. By adding covariates to the model the sensitivity was increased to 46.3%, with a specificity of 90.1%. This increased the number of correctly classified by 5.6% and the area under the curve by 11.1%. CONCLUSION: The Johns Hopkins ACG Case-Mix System is an important factor in measuring comorbidity, however it does not reflect an individual's capability to function despite a disease burden, which has importance for prediction of comorbidity. In this study we have shown that information on such factors, which can be obtained from short questionnaires increases the probability to correctly predict an individual's use of resources, such as medications.

U2 - 10.1186/1471-2458-6-171

DO - 10.1186/1471-2458-6-171

M3 - Journal article

VL - 6

SP - 171

JO - B M C Public Health

JF - B M C Public Health

SN - 1471-2458

ER -