[Comparison of three methods for measuring multiple morbidity according to the use of health resources in primary healthcare].
OBJECTIVE
To compare three methods of measuring multiple morbidity according to the use of health resources (cost of care) in primary healthcare (PHC).


METHODS
Retrospective study using computerized medical records.


METHODS
Thirteen PHC teams in Catalonia (Spain).


METHODS
Assigned patients requiring care in 2008.


METHODS
The socio-demographic variables were co-morbidity and costs. Methods of comparison were: a) Combined Comorbidity Index (CCI): an index itself was developed from the scores of acute and chronic episodes, b) Charlson Index (ChI), and c) Adjusted Clinical Groups case-mix: resource use bands (RUB). The cost model was constructed by differentiating between fixed (operational) and variable costs.


METHODS
3 multiple lineal regression models were developed to assess the explanatory power of each measurement of co-morbidity which were compared from the determination coefficient (R(2)), p< .05.


RESULTS
The study included 227,235 patients. The mean unit of cost was €654.2. The CCI explained an R(2)=50.4%, the ChI an R(2)=29.2% and BUR an R(2)=39.7% of the variability of the cost. The behaviour of the ICC is acceptable, albeit with low scores (1 to 3 points), showing inconclusive results.


CONCLUSIONS
The CCI may be a simple method of predicting PHC costs in routine clinical practice. If confirmed, these results will allow improvements in the comparison of the case-mix.
Antoni
A
Sicras-Mainar
Soledad
S
Velasco-Velasco
Ruth
R
Navarro-Artieda
Milagrosa
M
Blanca Tamayo
Alba
A
Aguado Jodar
Amador
A
Ruíz Torrejón
Alexandra
A
Prados-Torres
Concepción
C
Violan-Fors
D000328:Adult; D015897:Comorbidity; D003365:Costs and Cost Analysis; D004812:Epidemiologic Methods; D005260:Female; D006295:Health Resources / Q000191:economics* / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D011320:Primary Health Care / Q000191:economics* / Q000706:statistics & numerical data*; D012189:Retrospective Studies