Several coordinated strategies for the care of people with chronic diseases have been implemented in Spain for approximately ten years now. The main reason for this prominence of chronicity in the global health policy agenda is that it is assumed to be the main cause of morbidity and mortality. On the other hand, stratification, based on predictive models, has become the most important axis on which these strategies gravitate. Stratification consists in segmenting people with chronic diseases according to their use of the health care services and their cost. In this sense, different levels of needs are identified and interventions are implemented in each group with the main purpose of better managing the presence of multiple chronic diseases and advanced chronicity, reducing hospital admissions and emergency care demands, and achieving a more adequate use of medicines.
The Strategy for Addressing Chronicity (Estrategia para el Abordaje de la Cronicidad) in the Spanish National Health System (Sistema Nacional de Salud) proposes the prioritization of patients based on a Kaiser-type pyramid:
- Level 0: healthy people with or without risk factors.
- Level 1: presence of 1 or 2 chronic diseases. Low-risk patients with conditions still in the early stages.
- Level 2: complex chronic patients (CCPs). Presence of multiple diseases, with 3 or 4 being chronic diseases. High-risk patients, but of lesser complexity.
- Level 3: patients with an advanced chronic disease (MACA). Patients with multiple chronic diseases and an increased fragility burden. Presence of five or more chronic diseases.
On the other hand, there is much evidence that health inequalities do exist and that they have a socioeconomic basis, with a non-insignificant proportion of them being caused by environmental problems. These factors are generally, but not exclusively, linked to socioeconomic conditions. However, to date, most predictive stratification models fail to consider these socioeconomic inequalities and none of them consider environmental inequality. As a result, some patients may be poorly stratified, which could have important implications with respect to the main health care strategy, the use of specialized hospital care, and, therefore, the allocation of available resources.
We carried out a review of the scientific literature and defined several objectives:
- Use of RWD to develop an algorithm to evaluate the complexity of chronic patients, controlled for socioeconomic and environmental inequalities.
- Estimation of the probability of survival within the following 12 months of people with chronic diseases, controlled for socioeconomic and environmental inequalities (exposure and differential susceptibility).
In order to achieve these objectives, in March 2019, we requested data on people with and without chronic diseases in the Alt Empordà region to the Analysis of Data on Health Research and Innovation Program (PADRIS, Programa d’Analítica de Dades per a la Recerca i la Innovació en Salut) of the Catalonian Agency for Health Care Quality and Assessment (AQuAS, Agència de Qualitat i Avaluació Sanitàrias). We received these data in May 2020 and are currently processing them for further analysis.