Characterization of Patients with Chronic Diseases and Complex Care Needs: A New High-Risk Emergent Population

Bernabeu Wittel M*; Garcia Romero L; Murcia Zaragoza J; Gamez Mancera R; Aparicio Santos R; Diez Manglano J; Lopez de la Fuente M; Vogt Sanchez EA; Villarino Marzo M; Aquilino Tari A; Herranz Martinez S; Diaz Jimenez P; Ollero Baturone M; Rosich Peris MP; Cronicom Project researchers

Bernabeu Wittel M*, Garcia Romero L, Murcia Zaragoza J, Gamez Mancera R, Aparicio Santos R, Diez Manglano J, Lopez de la Fuente M, Vogt Sanchez EA, Villarino Marzo M, Aquilino Tari A, Herranz Martinez S, Diaz Jimenez P, Ollero Baturone M, Rosich Peris MP and Cronicom Project researchers

Volume3-Issue11
Dates: Received: 2022-11-07 | Accepted: 2022-11-19 | Published: 2022-11-21
Pages: 1321-1336

Abstract

Background: To analyze the prevalence and main epidemiological, clinical and outcome features of in-Patients with Complex Chronic conditions (PCC) in internal medicine areas, using a pragmatic working definition.

Methods: Prospective study in 17 centers from Spain, with 97 in-hospital, monthly prevalence cuts. A PCC was considered when criteria of polypathological patient (two or more major chronic diseases) were met, or when a patient suffered one major chronic disease plus one or more of nine predefined complexity criteria like socio-familial risk, alcoholism or malnutrition among others (PCC without polypathology). A complete set of baseline features as well as 12-months survival were collected. Then, we compared clinical, outcome variables, and PROFUND index accuracy between polypathological patients and PCC without polypathology.

Results: The global prevalence of PCC was 61% (40% of them were polypathological patients, and 21% PCC withouth polypathology) out of the 2178 evaluated patients. Their median age was 82 (59.5% men), suffered 2.3 ± 1.1 major diseases (heart diseases (70.5%), neurologic (41.5%), renal (36%), and lung diseases (26%)), 5.5 ± 2.5 other chronic conditions, met 2.5 ± 1.5 complexity criteria, and presented functional decline (Barthel index 55 (25-90)). Compared to polypathological patients, the subgroup of PCC without polypathology were younger, with a different pattern of major diseases and comorbidities, a better functional status, and lower 12-months mortality rates ((36.2% vs 46.8%; p = .003; OR 0.7(0.48-0.86). The PROFUND index obtained adequate calibration and discrimination power (AUC-ROC 0.67 (0.63-0.69)) in predicting 12-month mortality of PCC.

Conclusion: Patients with complex chronic conditions are highly prevalent in internal medicine areas; their clinical pattern has changed in parallel to socio-epidemiological modifications, but their death-risk is still adequately predicted by PROFUND index.

FullText HTML FullText PDF DOI: 10.37871/jbres1601

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Bernabeu Wittel M, García Romero L, Murcia Zaragoza J, Gámez Mancera R, Aparicio Santos R, Díez Manglano J, López de la Fuente M, Vogt Sánchez EA, Villarino Marzo M, Aquilino Tarí A, Herranz Martínez S, Díaz Jiménez P, Ollero Baturone M, Rosich Peris MP, Cronicom Project researcher. Characterization of Patients with Chronic Diseases and Complex Care Needs: A New High-Risk Emergent Population. 2022 Nov 21; 3(11): 1321-1336. doi: 10.37871/jbres1601, Article ID: JBRES1601, Available at: https://www.jelsciences.com/articles/jbres1601.pdf

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