Patient based ‘burden‐of‐illness’ in Swedish primary health care. Applying the Johns Hopkins ACG case‐mix system in a retrospective study of electronic patient records

Abstract

Patients from one municipality in Sweden utilizing primary health care (PHC) during 1998 and 1999 have been categorized into 81 groups. The groups show each patient's own case-mix in terms of illness. Grouping was carried out using the case-mix instrument adjusted clinical groups (ACG), developed by the School of Hygiene and Public Health at Johns Hopkins University in Baltimore, USA. The resulting pattern provided a more adequate reflection of the scope of primary care's task than that yielded by diagnoses alone. Changes over time in terms of illness patterns for a population could be described, analysed and assessed from medical and health economic perspectives. One of the conclusions from this study was that the ACG instrument is a relevant tool in describing the outcome of work by the primary health care centre. The ACG is of interest in the improvement of the quality of primary care in Sweden. The ACG should be a driving force in the development of health indices in both national and international comparisons, as a result of its focus on the health status of patients and populations instead of on diagnoses and diseases.

Recurrence of inguinal hernias repaired in a large hernia surgical specialty hospital and general hospitals in Ontario, Canada

“…We assessed comorbidity using the Johns Hopkins Case-Mix Adjusted Clinical Groups (ADG) comorbidity score. 9,10 Overall comorbidity was estimated by summing the presence of each of the 12 Collapsed ADG Clusters (CADG) and further stratified into low and high comorbidity levels, with a score of 7 or greater indicating high comorbidity.…”

Association between Frequency of Telephonic Contact And Clinical Testing for A Large, Geographically Diverse Diabetes Disease Management Population

“…Disease burden was estimated based on the amount of healthcare resources a member utilized and expressed as a resource utilization band (RUB) score ranging from zero (no utilization) to five (highest utilization) using the Johns Hopkins ACG tool. 18 A RUB score was calculated for each member based on healthcare utilization during the first 12 months in a DM program.…”

Types of morbidity and categories of patients in a Swedish countyApplying the Johns Hopkins adjusted clinical groups system to encounter data in primary health care

“…Time limited health conditions were most frequent, and the two most common categories of types of morbidity were ''time limited'' and ''recurrent'', without any other type of morbidity, and these comprised 50.1% of all patients. The predominant categories of patients were those with only one type of morbidity, and the ACG distribution provided a new view, as compared with statistics concerning diagnoses and diseases, categories of patients, and the burden of morbidity in a population, as was pointed out in a previous study (9). Data from encounters with a GP at privately managed primary care units in Blekinge county council were not retrievable because of lack of electronic databases.…”

“…The principal information concerning the ACG system and the grouping algorithms has been published elsewhere (9). The end result of the grouping is that each patient is allotted to one, and no more than one, ACG, depending on his/her registered type or types of morbidity.…”

“…It has been used in a number of trials in Sweden, in preparation for routine use. Results from one municipality have been published, demonstrating the feasibility on a district level (9).…”