Research Article: Association between Johns Hopkins Adjusted Clinical Groups risk scores and self-reported outcome measures: an observational study among individuals with complex or long-term conditions in Norway
Abstract:
Objective Investigate the association between Johns Hopkins Adjusted Clinical Groups (ACG) risk scores and low scores in self-reported outcome measures (SROMs) among individuals with complex or long-term conditions. Design Longitudinal study using five ACG risk scores based on diagnoses from general practitioner (GP) visits in 1?year and responses to a survey including three SROMs 4?months later. Setting Four adjacent municipalities in Central Norway. Participants Non-institutionalised individuals ?18 years with ?1 diagnosis code indicating a complex or long-term condition, ?1 visit to a GP, and who participated in the survey (n=2944). Measures Dependent variables were low scores in the three SROMs (threshold for being defined as a low score in parentheses): Patient Activation Measure (level 1–2), EQ-5D (<0.4) or self-rated health (‘Poor’). Independent variables were five ACG variables. Results The individuals with the lowest scores in the three SROMs were mostly three separate groups. The lowest Patient Activation Measure scores were associated with high scores in the ACG variables unscaled total cost predicted risk (adjusted odds ratio (adjOR) 1.80) and positive frailty flag (adjOR 1.76). The lowest EQ-5D scores were associated with high scores in the ACG variables unscaled concurrent risk (adjOR 1.60) and probability persistent high user scores (adjOR 2.83). The lowest self-rated health scores were associated with high scores in the ACG variable unscaled concurrent risk scores (adjOR 1.77), unscaled total cost predicted risk scores (adjOR 2.14) and receiving a positive frailty flag (adjOR 1.82). Conclusions There were associations between ACG risk scores and subsequent low SROM scores. This suggests a potential to use diagnosis-based risk stratification systems as a proxy for SROMs to identify individuals with complex or long-term conditions for person-centred healthcare intervention.
Introduction:
Managing complex or long-term conditions requires person-centred and individually oriented care. 1 Despite increasing attention, healthcare services still struggle to provide high-quality healthcare to individuals with the most complex healthcare needs. 2 3 While developing interventions to effectively improve chronic care management is an important step, it is equally important to identify those most likely to benefit from such interventions. 4 This identification process is typically conducted within the domain…
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