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

ObjectiveInvestigate 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.DesignLongitudinal 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.SettingFour adjacent municipalities in Central Norway.ParticipantsNon-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).MeasuresDependent 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.ResultsThe 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).ConclusionsThere 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.

Endoscopic Repair of Anterior Skull Base Cerebrospinal Fluid Leaks is Successful in Frail Patients

“…The frailty metrics in this study were amenable to retrospective analysis but future prospective work is planned using other tools (e.g., Groningen Frailty Indicator, Johns Hopkins Adjusted Clinical Groups) to better address this deficiency in the current analysis. 19,20 Finally, we did not collect length of stay or nonhome discharge in this dataset given that our primary focus was on overall success rate and 30-day medical and surgical complications. These are both important metrics and will be considered as secondary outcomes in future studies.…”

“…Importantly, frailty metrics utilized in this study focus primarily on medical comorbidities and cannot fully capture functional impairments, which may be more relevant metrics when assessing a patient's perioperative risk. The frailty metrics in this study were amenable to retrospective analysis but future prospective work is planned using other tools (e.g., Groningen Frailty Indicator, Johns Hopkins Adjusted Clinical Groups) to better address this deficiency in the current analysis 19,20 . Finally, we did not collect length of stay or nonhome discharge in this dataset given that our primary focus was on overall success rate and 30‐day medical and surgical complications.…”