A new multimorbidity grouper 新的多种疾病族群High
EXPLANATORY STRENGTH 高判断能力
Explanatory strength has been validated and benchmarked against alternate measurement methodologies
判断能力与替代测量方案比较评估证实
HIGH PREDICTIVE STRENGTH 高预测能力
Predictive strength has been validated and benchmarked against alternative measurement methodologies
预测能力与替代测量方案比较评估证实
CLINICALLY TESTED 经过临床检测
Predictive strength has been validated and benchmarked against alternative measurement methodologies
AMG 经过临床管理与复杂性测量证实
FLEXIBLE AND ADAPTABLE 灵活性与适应性
As AMGs are generated by a quantitative, empirical complexity model, it can be recalculated using current health care information system data (population)
AMG 以定量、实证的复杂性模型制作,可使用目前保健信息系统数据 (人口) 重新计算
1. AMG
Adjusted
Morbidity
Groups
调整后的发病族群
A
new
mul5-‐morbidity
grouper
新的多种疾病族群
Barcelona
巴塞罗那
Emili
Vela
Montse
Clèries
David
Monterde
2. Foreword
and
mo5va5on:
前言和动机:
The
relevance
of
mul5-‐morbidity
多种疾病的相关性
Mul7-‐morbidity
is
the
norm
rather
than
the
excep5on
多种疾病是经常发生的状况而非例外
Pa7ents
with
mul7-‐morbidity
show
lower
quality
life
scores,
and
demand
higher
health
care
resources
患有多种疾病的患者显示较低的生活质量积分,而且需要较多保健资源
Low
effec7veness
of
disease-‐oriented
treatment
in
mul7-‐morbidity
pa7ents
多种疾病患者疾病导向治疗效益低落
A
tool
to
measure
mul7-‐morbidity
is
required
需要能够测量多种疾病的工具
Mul7-‐morbidity
benchmarking
goes
beyond
of
just
lis5ng
of
(chronic)
diagnoses
involved
多种疾病标竿分析不仅只是列出相关的(慢性)诊断
Other
factors
such
as
“total
mul7-‐morbidity
load”
must
also
be
take
into
considera7on
其他像是“多种疾病总体负荷”也必须列入考虑
The
Lancet,
BMJ,
J
Clinical
Epidemiology,
JAMA,
Ann
Fam
Pract
Adjusted
morbidity
groups
调整后的发病族群
3. CRG
AMG
Mul5-‐morbidity
aggregator
elements
多种疾病族群组成因素
MORBIDITY-‐BASED
以发病为基础
POPULATION
人口
AGGREGATOR
MODEL
群集模式
CLUSTERING
群集
STRATIFICATION
分层
IDENTIFICATION
识别
Adjusted
morbidity
groups
调整后的发病族群
4. Health
care
quality
医疗质量
Efficiency
效率
Benchmarking
标竿分析
Evalua7on
评估
Decision
criteria
决策标准
Mul5-‐morbidity
aggregator
benefits
多种疾病族群的益处
• Health
care
prac5ce
医疗工作
• Informa7on
for
professionals
提供专业人员信息
• Pa7ent
iden7fica7on
患者识别
• Chronic
pa7ent
follow-‐up
慢性患者追踪
• Preven7ve
ac7ons
on
high
risk
pa7ents
高危险患者的预防措施
• Indicators
management
指标管理
• Predic7ve
model
design
预测模型设计
• Benchmarking
标竿分析
• Con7nued
improvement
持续改善
• Resource
management
资源管理
• Human
resources
management
人力资源管理
Adjusted
morbidity
groups
调整后的发病族群
5. Mul5-‐morbidity
aggregator
benefits
多种疾病族群的益处
DECISION
SUPPORT
决策支持
KNOWLEDGE
知识
INFORMATION
信息
GMA
UTILITIES
效⽤用
Adjusted
morbidity
groups
调整后的发病族群
6. Clinical
data
sources:
Big
Data
临床数据资源:
大数据
Adjusted
morbidity
groups
调整后的发病族群
*
Available
informa5on
belonging
to
the
7.5
milion
inhabitants
(during
the
analysis
period
and
previous
years)
*
获得 750 万居民的信息
(在分析期间与过去几年)
Yearly
data
of
7.5
million
ci3zens:
750
万公民年度数据:
v
700.000
hospitaliza7ons
70 万住院人次
v
45
millions
of
primary
care
visits
4 千 5
百万一级保健人
次
v
4
millions
emergency
room
visits
4
百万急诊室人次
v
1
million
visits
to
Mental
Health
centers
1
百万心理卫生中心人次
v
100.000
visits
to
socio-‐sanitary
centers
10 万社康中心人次
v
150
millions
of
drug
prescrip7ons
1 亿 5 千万药物处方
v
62
millions
of
diagnoses
records
6 千 2
百万诊断记录
7.5
million
ci5zens
750
万公民
267
million
diagnoses
*
2 亿 6 千 7
百万项诊断
*
255
million
visits
*
2 亿 5 千 5
百万人次
*
360
million
prescrip5ons
*
3 亿 6 千万件处方
*
7. AMG
Basic
Architecture
基本结构
Disease
profile
疾病档案
Acute,
chronic
or
ac7ve
cancer
急性、慢性或目前患有癌症
Mul5-‐morbidity
多种疾病
On
pa7ents
with
chronic
disease
慢性疾病的患者
Complexity
复杂性
Based
on
morbidity
burden
依据发病负荷
ACTIVE CANCER
目前患有癌症
CHRONIC DISEASE (4+ SYSTEMS)
慢性疾病 (4 个以上系统)
CHRONIC DISEASE (2-3 SYSTEMS)
慢性疾病 (2-3 个系统)
CHORNIC DISEASE (1 SYSTEM)
慢性疾病 (1 个系统)
ACUTE PATHOLOGY
急性病理
PREGNANCY AND DELIVERTY
怀孕与分娩
HEALTHY POPULATION
健康人口
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
MAJOR MORBIDITY GROUP
重要疾病族群
COMPLEXITY LEVEL
复杂等级
MULTI-MORBIDITY
多种疾病
COMPLEXITY
复杂性
Adjusted
morbidity
groups
调整后的发病族群
9. Adjusted
Morbidity
Groups:
调整后的发病族群:
A
new
mul5-‐morbidity
grouper
新的多种疾病族群
AMGs
classify
pa5ents
into
unique
groups
AMG
将患者分为单独的组别
Each
pa7ent
belongs
to
a
unique
group
每位患者都有各自的族群
AMGs
take
into
account
the
health
profile
AMG
将健康档案列入考虑
It
specifically
dis7nguish
between
acute,
chronic
and
ac7ve
cancer
at
a
certain
period
特别区分急性、慢性以及各时期的癌症
AMGs
provide
specific
informa5on
on
each
pa5ent
AMG
提供每位患者的特定信息
Each
pa7ent
has
its
own
health
profile
(morbidity
summary)
and
his
complexity
level
(according
to
the
care
demand
level
associated
to
his
morbidity
profile)
每位患者皆有自己的健康档案 (疾病摘要)
与复杂等级 (依据与患者疾病
档案相关的护理需求等级)
Adjusted
morbidity
groups
调整后的发病族群
10. Evalua5on
of
AMGs
explanatory
strength
评估 AMG
的判断能力
0
5
10
15
20
25
30
35
40
Edad
+
Sexo
Edad
+
Sexo
+
Charlson
Edad
+
Sexo
+
ACG
PRIMARY
CARE
VISITS
一级护理人次
%
OF
VARIABILITY
EXPLAINED
%
判断变异性
“Comparing
measures
of
mul5-‐morbidity
to
predict
outcomes
in
primary
care:
a
cross
sec5onal
study”
“多种疾病比较方式
预测一级护理结果:
一项跨领域研究”
Brilleman,
Samuel
L
and
Salisbury,
Chris
2013.
Family
Prac+ce
AGE
+
GENDER
年龄
+
性别
AGE
+
GENDER
+
CHARLSON
年龄
+
性别
+
CHARLSON
AGE
+
GENDER
+
ACG
年龄
+
性别
+
ACG
Adjusted
morbidity
groups
调整后的发病族群
11. 0
10
20
30
40
50
60
Edad
+
Sexo
Edad
+
Sexo
+
n
Crónicas
Edad
+
Sexo
+
GMA
PRIMARY
CARE
VISIT
一级护理人次
%
OF
VARIABILITY
EXPLAINED
%
判断变异性
0
10
20
30
40
50
60
Edad
+
Sexo
Edad
+
Sexo
+
n
Crónicas
Edad
+
Sexo
+
GMA
PHARMACY
SHOP
VISIT
药局选购
%
OF
VARIABILITY
EXPLAINED
%判断变异性
0.60
0.65
0.70
0.75
0.80
0.85
Edad
+
Sexo
Edad
+
Sexo
+
n
Crónicas
Edad
+
Sexo
+
GMA
HOSPITAL
ADMISSION
RISK
住院风险
AUC
(ROC)
Evalua5on
of
AMGs
explanatory
power
评估 AMG
的判斷优势
Adjusted
morbidity
groups
调整后的发病族群
AGE
+
GENDER
+
AMG
年龄
+
性别
+
AMG
AGE
+
GENDER
+
CRG
年龄
+
性别
+
CRG
AGE
+
GENDER
+
N
CHRONIC
年龄
+
性别
+
N
CHRONIC
AGE
+
GENDER
年龄
+
性别
AGE
+
GENDER
+
CHARLSON
年龄
+
性别
+
CHARLSON
AGE
+
GENDER
+
AMG
年龄
+
性别
+
AMG
AGE
+
GENDER
+
CRG
年龄
+
性别
+
CRG
AGE
+
GENDER
+
N
CHRONIC
年龄
+
性别
+
N
CHRONIC
AGE
+
GENDER
年龄
+
性别
AGE
+
GENDER
+
CHARLSON
年龄
+
性别
+
CHARLSON
AGE
+
GENDER
+
AMG
年龄
+
性别
+
AMG
AGE
+
GENDER
+
CRG
年龄
+
性别
+
CRG
AGE
+
GENDER
+
N
CHRONIC
年龄
+
性别
+
N
CHRONIC
AGE
+
GENDER
年龄
+
性别
AGE
+
GENDER
+
CHARLSON
年龄
+
性别
+
CHARLSON
12. 0
5
10
15
20
25
30
Edad
+
Sexo
Edad
+
Sexo
+
CRG
Edad
+
Sexo
+
GMA
RISK
OF
URGENCY
ROOM
ADMISSION
急诊室住院风险
SENSIBILITY
(VP+)
敏感度(VP+)
Evalua5on
of
AMGs
predic5ve
power
评估 AMG
的预测优势
AGE
+
GENDER
+
AMG
年龄
+
性别
+
AMG
AGE
+
GENDER
+
CRG
年龄
+
性别
+
CRG
AGE
+
GENDER
年龄
+
性别
The
predic7ve
power
of
AMGs
is
under
evalua7on
AMG
的预测能力受到低估
The
threshold
used
is
the
meaningful
epidemiologic
value,
rather
than
the
op7mum
predictor
value
使用的阈值是有效流行病学数值,
而非最佳预测值
Adjusted
morbidity
groups
调整后的发病族群
13. Popula5on
stra5fica5on
using
AMG
使用 AMG
将人口分层
MORTALITY
ADMISSIONS
EXPENSE
TOTAL
死亡率 住院率 花费 总百分比
Adjusted
morbidity
groups
调整后的发病族群
MORTALITY: deaths per 1000 inhabitants
死亡率:每 1000 位居民死亡数
ADMISSIONS: admissions per 100 inhabitants
住院率:每 100 位居民住院数
EXPENSE: annual cost per patient
花费: 每位患者年度花费
TOTAL: % compared to the total
总百分比:相较总数之百分比
14. CHRONIC
DISEASE
IN
4+
SYSTEMS
四个以上的系统患有慢性疾病
COPD
+
T2D+
HBP
+
ARTHROSIS
+
PANCREATITIS
慢性阻塞性肺病 +
第二型糖尿病 +
高血压
+
关节炎
+
胰脏炎
RISK
OF
DEATH:
死亡风险:
RISK
OF
ADMISSION:
住院风险:
Integra5ng
of
AMG
into
case
management
将 AMG
用于病例管理
PATIENT:
John
Smith
患者:
王大年
AGE:
67
年龄:
67
岁
GENDER:
MALE
性别:
男性
AMG
+
HEALTH
PROFILE
AMG
+
健康档案
COMPLEXITY
LEVEL
复杂等级
INDICATORS
&
AUTOMATED
RISK-‐BASED
ALERTS
指标与自动风险基准警示
FOLLOW
UP
REQUIRED
需要追踪
Adjusted
morbidity
groups
调整后的发病族群
15. Summary
总结
High
explanatory
strength
高判断能力
Explanatory
strength
has
been
validates
and
benchmarked
against
alterna7ve
measurement
methodologies
判断能力与替代测量方案比较评估证实
High
predic5ve
strength
高预测能力
Predic7ve
strength
has
been
validates
and
benchmarked
against
alterna7ve
measurement
methodologies
预测能力与替代测量方案比较评估证实
Clinically
tested
经过临床检测
Predic7ve
strength
has
been
validates
and
benchmarked
against
alterna7ve
measurement
methodologies
AMG
经过临床管理与复杂性测量证实
Flexible
and
adaptable
灵活性与适应性
As
AMGs
are
generated
by
a
quan7ta7ve,
empirical
complexity
model,
it
can
be
re-‐calculated
using
current
health
care
informa7on
system
data
(popula7on)
AMG 以定量、实证的复杂性模型制作,可使用目前保健信息系统数据 (人口) 重新计算
Adjusted
morbidity
groups
调整后的发病族群
16. Emili
Vela
Montse
Clèries
David
Monterde
Thank
you
for
your
aden5on
感谢您的关注
Adjusted
morbidity
groups
调整后的发病族群