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A multi-state approach to patients affected by chronic heart failure

The value added by administrative data

Abstract

Healthcare administrative databases are becoming more and more important and reliable sources of clinical and epidemiological information. They are able to track several interactions between a patient and the public healthcare system. In the present study, we make use of data extracted from the administrative data warehouse of Regione Lombardia, a region located in the northern part of Italy whose capital is Milan. Data are within a project aiming at providing a description of the epidemiology of Heart Failure (HF) patients at regional level, to profile health service utilization over time, and to investigate variations in patient care according to geographic area, socio-demographic characteristic and other clinical variables. We use multi-state models to estimate the probability of transition from (re)admission to discharge and death adjusting for covariates which are state dependent. To the best of our knowledge, this is the first Italian attempt of investigating which are the effects of pharmacological and outpatient cares covariates on patient’s readmissions and death. This allows to better characterise disease progression and possibly identify what are the main determinants of a hospital admission and death in patients with Heart Failure.

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Notes

  1. 1.

    We record the following procedures: heart circulatory system shock, ICD (Inplantable Cardioverter Defribillator), CABG (Coronary Artery Bypass Grafting) or PTCA (Percutaneous Transluminal Coronary Angioplasty)

  2. 2.

    We record many comorbidities like: metastatic, dementia, renal, weight loss, hemiplegia, alcohol abuse, tumor, arrhythmia, hypertension, pulmonary disease, coagulopathy, diabetes, anemia, electrolytes, liver, Peripheral Arterial Disease (PVD), psychosis, pulmonary circulation, HIV/AIDS.

  3. 3.

    Direct link to download the package: https://CRAN.R-project.org/package=msmtools

  4. 4.

    We fictitiously indicate the last state in which we see a patient.

  5. 5.

    The comorbidity score does not intervene in this transition.

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Correspondence to Francesco Grossetti.

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Grossetti, F., Ieva, F. & Paganoni, A.M. A multi-state approach to patients affected by chronic heart failure. Health Care Manag Sci 21, 281–291 (2018). https://doi.org/10.1007/s10729-017-9400-z

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Keywords

  • Administrative data
  • Chronic heart failure
  • Multi-state models
  • Survival analysis
  • Data management