Clustering Complex Chronic Patients: A Cross-Sectional Community Study From the General Practitioner's Perspective

Abstract

Objective: Characterize subgroups of Complex Chronic Patients (CCPs) with cluster analysis from the general practitioner's perspective.

Study design: Cross-sectional population-based study.

Setting: Three Primary Care urban centres for a reference population of 43,647 inhabitants over 14 years old in Sabadell, Catalonia, Spain.

Methods: Complexity is defined by the independent clinical judgment of general practitioners with the aid of complexity domains (both clinical and social). We used a Two-Step Cluster method to identify relevant subgroups of CCPs.

Results: Three relevant subgroups were identified. The first one was mainly managed by primary care professionals, and 63% of its CCPs belonged to the high-risk stratum of the Adjusted Morbidity Groups (GMA). The second subgroup included younger patients than the other two clusters, and showed the highest ratios of social deprivation and severe mental disease; 48% of its CCPs belonged to the high-risk stratum of the GMA. A third cluster included patients who belonged to the high-risk stratum of the GMA. Their age was similar to that of the patients in the first cluster, but they showed the highest values in the following areas: (i) risk of admission; (ii) proportion of advanced chronic disease and limited-life prognosis; (iii) functional loss and (iv) geriatric syndromes, along with special uncertainty in decision-making and clinical management.

Conclusions: Characterization of CCPs shows clearly distinct profiles of needs, which provides an improved epidemiological picture by identifying clusters of patients who are likely to benefit from targeted interventions.

Keywords: complex care needs; complex chronic patient; integrated care; multimorbidity; patients’ complexity clusters; primary care.

Figure 1

Sampling framework for data collection.

Figure 2

Prevalence of complexity by age and cluster.

Figure 3

(i) Physicians’ perspective as the gold standard vs. GMA 4. a = False Positive, TP = True Positive, b = False Negative; (ii) GMA 4 as the gold standard vs. physicians’ perspective. a = False Negative, TP = True Positive, b = False Positive. In our data, 60.6% of CCPs are located in the GMA 4 stratum, 32% of CCPs are located in the GMA3 stratum and 7.4% of them are located in the GMA 2 stratum.