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首页> 外文期刊>BMC Family Practice >Identifying heterogeneous health profiles of primary care utilizers and their differential healthcare utilization and mortality – a retrospective cohort study
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Identifying heterogeneous health profiles of primary care utilizers and their differential healthcare utilization and mortality – a retrospective cohort study

机译：识别初级保健使用者的异质性健康状况及其不同的保健利用率和死亡率–一项回顾性队列研究

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Heterogeneity of population health needs and the resultant difficulty in health care resources planning are challenges faced by primary care systems globally. To address this challenge in population health management, it is critical to have a better understanding of primary care utilizers’ heterogeneous health profiles. We aimed to segment a population of primary care utilizers into classes with unique disease patterns, and to report the 1?year follow up healthcare utilizations and all-cause mortality across the classes. Using de-identified administrative data, we included all adult Singapore citizens or permanent residents who utilized Singapore Health Services (SingHealth) primary care services in 2012. Latent class analysis was used to identify patient subgroups having unique disease patterns in the population. The models were assessed by Bayesian Information Criterion and clinical interpretability. We compared healthcare utilizations in 2013 and one-year all-cause mortality across classes and performed regression analysis to assess predictive ability of class membership on healthcare utilizations and mortality. We included 100,747 patients in total. The best model (k?=?6) revealed the following classes of patients: Class 1 “Relatively healthy” (n?=?58,213), Class 2 “Stable metabolic disease” (n?=?26,309), Class 3 “Metabolic disease with vascular complications” (n?=?2964), Class 4 “High respiratory disease burden” (n?=?1104), Class 5 “High metabolic disease without complication” (n?=?11,122), and Class 6 “Metabolic disease with multi-organ complication” (n?=?1035). The six derived classes had different disease patterns in 2012 and 1 year follow up healthcare utilizations and mortality in 2013. “Metabolic disease with multiple organ complications” class had the highest healthcare utilization (e.g. incidence rate ratio?=?19.68 for hospital admissions) and highest one-year all-cause mortality (hazard ratio?=?27.97). Primary care utilizers are heterogeneous and can be segmented by latent class analysis into classes with unique disease patterns, healthcare utilizations and all-cause mortality. This information is critical to population level health resource planning and population health policy formulation.
机译：人口卫生需求的异质性以及由此导致的卫生保健资源规划方面的困难是全球初级卫生保健系统面临的挑战。为了应对人口健康管理中的这一挑战，至关重要的是要更好地了解初级保健使用者的异构健康状况。我们的目标是将初级保健使用者人群划分为具有独特疾病模式的类别，并报告各类别中1年随访医疗保健使用率和全因死亡率。使用身份不明的行政数据，我们纳入了所有在2012年使用新加坡卫生服务（SingHealth）基本医疗服务的成年新加坡公民或永久居民。使用潜在类别分析来确定人群中具有独特疾病模式的患者亚组。通过贝叶斯信息准则和临床可解释性评估模型。我们比较了2013年的医疗保健利用率和各班级的一年全因死亡率，并进行了回归分析，以评估班级成员对医疗保健利用率和死亡率的预测能力。我们总共包括100,747名患者。最佳模型（k？=？6）显示以下几类患者：1级“相对健康”（n？= 58,213），2级“稳定的代谢性疾病”（n？= 26,309），3级“代谢”伴有血管并发症的疾病”（n = 2964），第4类“呼吸道疾病高负担”（n = 1104），第5类“无并发症的高代谢疾病”（n = 11122）和第6类“多器官并发症的代谢性疾病”（n = 1035）。六个派生类在2012年和2013年的随访中使用了不同的疾病模式，并在2013年对患者进行了随访。“代谢性疾病伴多器官并发症”类的医疗使用率最高（例如，住院患者的发病率？=？19.68）和一年全因死亡率最高（危险比？=？27.97）。初级保健利用者是异类的，可以通过潜在类别分析将其细分为具有独特疾病模式，医疗保健利用和全因死亡率的类别。这些信息对于人口级卫生资源规划和人口卫生政策制定至关重要。

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