Dissertations / Theses on the topic 'Clinical risk prediction'
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Townsend, Daphne. "Clinical trial of estimated risk stratification prediction tool." Thesis, University of Ottawa (Canada), 2007. http://hdl.handle.net/10393/27926.
Full textJackson, Rebecca L. "Contextualized Risk Assessment in Clinical Practice: Utility of Actuarial, Clinical, and Structured Clinical Approaches to Predictions of Violence." Thesis, University of North Texas, 2004. https://digital.library.unt.edu/ark:/67531/metadc4603/.
Full textGrant, Stuart William. "Risk prediction models in cardiovascular surgery." Thesis, University of Manchester, 2014. https://www.research.manchester.ac.uk/portal/en/theses/risk-prediction-models-in-cardiovascular-surgery(1befbc5d-2aa6-4d24-8c32-e635cf55e339).html.
Full textDonovan, Brittney Marie. "Early risk prediction tools for gestational diabetes mellitus." Diss., University of Iowa, 2018. https://ir.uiowa.edu/etd/6408.
Full textGhassemi, Marzyeh. "Representation learning in multi-dimensional clinical timeseries for risk and event prediction." Thesis, Massachusetts Institute of Technology, 2017. http://hdl.handle.net/1721.1/112389.
Full textThis electronic version was submitted by the student author. The certified thesis is available in the Institute Archives and Special Collections.
Cataloged from student-submitted PDF version of thesis.
Includes bibliographical references (pages 99-108).
There are major practical and technical barriers to understanding human health, and therefore a need for methods that thrive on large, complex, noisy data. In this work, we present machine learning methods that distill large amounts of heterogeneous health data into latent state representations. These representations are then used to estimate risks of poor outcomes, and response to intervention in multivariate physiological signals. We evaluate the reduced latent representations by 1) establishing their predictive value in important clinical tasks and 2) showing that the latent space representations themselves provide useful insight into underlying systems. In particular, we focus on case studies that can provide evidence-based risk assessment and forecasting in settings with guidelines that have not traditionally been data-driven. In this thesis we evaluate several methods to create patient representations, and use these features to predict important outcomes. Representation learning can be thought of as a form of phenotype discovery, where we attempt to discover spaces in the new representation that are markers of important events. We argue that these latent representations are useful markers when they 1) create better prediction results on outcomes of interest, and 2) do not duplicate features that are currently known bio-markers. We present four case studies of learning representations, and evaluate the representations on real predictive tasks. First, we create forward-facing prediction models using baseline clinical features, and those from a Latent Dirichlet Allocation (LDA) model trained with clinical progress notes. We then evaluate the per-patient latent state membership to predict mortality in an intensive care setting as time moves forward. Second, we use non-parametric Multi-task Gaussian Process (MTGP) hyper-parameters as latent features to estimate correlations within and between signals in sparse, heterogeneous time series data. We evaluate the hyper-parameters for forecasting missing signals in traumatic brain injury patients, and predicting mortality in intensive care unit patients. Third, we train switching-state autoregressive models (SSAMs) to model the underlying states that emit patient vital signs over time. We evaluate the time-specific latent state distributions as features to predict vasopressor onset and weaning in intensive care unit patients. Finally, we use statistical and symbolic features extracted from wearable ambulatory accelerometers (ACC) mounted to the neck to classify patient pathology, and stratify patients' risk of voice misuse. We evaluate the utility of both statistically generated features and symbolic representations of glottal pulses towards patient classification.
by Marzyeh Ghassemi.
Ph. D.
Olsson, Thomas. "Risk Prediction at the Emergency Department." Doctoral thesis, Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distributör], 2004. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-4632.
Full textPayne, Beth. "Development, validation and pilot implementation of the miniPIERS (Pre-eclampsia Integrated Estimate of RiSk) clinical risk prediction model." Thesis, University of British Columbia, 2014. http://hdl.handle.net/2429/51460.
Full textMedicine, Faculty of
Obstetrics and Gynaecology, Department of
Graduate
Yan, Jia. "Using Genetic Information in Risk Prediction for Alcohol Dependence." VCU Scholars Compass, 2012. http://scholarscompass.vcu.edu/etd/2878.
Full textMartínez, Millana Antonio. "ASSESSMENT OF RISK SCORES FOR THE PREDICTION AND DETECTION OF TYPE 2 DIABETES MELLITUS IN CLINICAL SETTINGS." Doctoral thesis, Universitat Politècnica de València, 2017. http://hdl.handle.net/10251/86209.
Full textLos indicadores de salud y sociológicos confirman que la esperanza de vida está aumentando, y por lo tanto, los años que los pacientes tienen que vivir con enfermedades crónicas y comorbilidades. Diabetes tipo 2 es una de las enfermedades crónicas más comunes, especialmente relacionadas con el sobrepeso y edades superiores a los sesenta años. Como enfermedad metabólica, la diabetes tipo 2 afecta a múltiples órganos causando daño en los vasos sanguíneos y el sistema nervioso a escala micro y macro. La mortalidad de sujetos con diabetes es tres veces mayor que la mortalidad de sujetos con otras enfermedades crónicas. Por un lado, la estrategia de manejo se centra en el mantenimiento de los niveles de glucosa en sangre bajo un umbral mediante la prescripción de fármacos antidiabéticos y una combinación de hábitos alimentarios saludables y actividad física moderada. Estudios recientes han demostrado la eficacia de nuevas estrategias para retrasar e incluso prevenir la aparición de la diabetes tipo 2 mediante una combinación de estilo de vida activo y saludable en cohortes de sujetos de riesgo medio a alto. Por otro lado, la investigación prospectiva se ha dirigido a grupos de la población para construir modelos de riesgo que pretenden obtener una regla para la clasificación de las personas según las probabilidades de desarrollar la enfermedad. Actualmente hay más de doscientos modelos de riesgo para hacer esta identificación, no obstante la inmensa mayoría no han sido debidamente evaluados en grupos externos y, hasta la fecha, ninguno de ellos ha sido probado en un estudio poblacional. El estudio de investigación presentado en esta tesis doctoral pretende utilizar modelos riesgo validados externamente para la predicción y detección de la Diabetes Tipo 2 en una base de datos poblacional del Hospital La Fe de Valencia (España). La hipótesis del estudio es que la integración de los modelos de riesgo de predicción y detección existentes la práctica clínica aumenta la detección temprana de casos de alto riesgo. Para evaluar esta hipótesis, se han realizado tres estudios sobre las dimensiones clínicas, del usuario y de la tecnología para evaluar hasta qué punto los modelos y el hospital están dispuestos a explotar dichos modelos para identificar grupos de alto riesgo y conducir estrategias preventivas eficaces. Los hallazgos presentados en esta tesis sugieren que los registros de salud electrónicos no están preparados para alimentar masivamente modelos de riesgo. Algunos de los modelos evaluados han demostrado un buen desempeño de clasificación, lo que acompañó a la buena aceptación de herramientas basadas en la web y el desempeño técnico aceptable del sistema de tecnología de información y comunicación, sugiere que después de algún trabajo estos modelos pueden conducir un nuevo paradigma de la detección activa de la Diabetes Tipo 2.
Els indicadors sociològics i de salut confirmen un augment en l'esperança de vida, i per tant, dels anys que les persones han de viure amb malalties cròniques i comorbiditats. la diabetis de tipus 2 és una de les malalties cròniques més comunes, especialment relacionades amb l'excés de pes i edats superiors als seixanta anys. Com a malaltia metabòlica, la diabetis de tipus 2 afecta múltiples òrgans causant dany als vasos sanguinis i el sistema nerviós a escala micro i macro. La mortalitat de subjectes amb diabetis és tres vegades superior a la mortalitat de subjectes amb altres malalties cròniques. D'una banda, l'estratègia de maneig se centra en el manteniment dels nivells de glucosa en sang sota un llindar mitjançant la prescripció de fàrmacs antidiabètics i una combinació d'hàbits alimentaris saludables i activitat física moderada. Estudis recents han demostrat l'eficàcia de noves estratègies per a retardar i fins i tot prevenir l'aparició de la diabetis de tipus 2 mitjançant una combinació d'estil de vida actiu i saludable en cohorts de subjectes de risc mitjà a alt. D'altra banda, la investigació prospectiva s'ha dirigit a grups específics de la població per construir models de risc que pretenen obtenir una regla per a la classificació de les persones segons les probabilitats de desenvolupar la malaltia. Actualment hi ha més de dos-cents models de risc per fer aquesta identificació, però la immensa majoria no han estat degudament avaluats en grups externs i, fins ara, cap d'ells ha estat provat en un estudi poblacional. L'estudi d'investigació presentat en aquesta tesi doctoral utilitza models de risc validats externament per a la predicció i detecció de diabetis de tipus 2 en una base de dades poblacional de l'Hospital La Fe de València (Espanya). La hipòtesi de l'estudi és que la integració dels models de risc de predicció i detecció existents la pràctica clínica augmenta la detecció de casos d'alt risc. Per avaluar aquesta hipòtesi, s'han realitzat tres estudis sobre les dimensions clíniques, de l'usuari i de la tecnologia per avaluar fins a quin punt els models i l'hospital estan disposats a explotar aquests models per identificar grups d'alt risc i conduir estratègies preventives. Les troballes presentades sugereixen que els registres de salut electrònics no estan preparats per alimentar massivament models de risc. Alguns dels models avaluats han demostrat una bona classificació, el que va acompanyar a la bona acceptació d'eines basades en el web i el rendiment tècnic acceptable del sistema de tecnologia d'informació i comunicacions implementat. La conclusió es que encara es necesari treball per que aquests models poden conduir un nou paradigma de la detecció activa de la diabetis de tipus 2.
Martínez Millana, A. (2017). ASSESSMENT OF RISK SCORES FOR THE PREDICTION AND DETECTION OF TYPE 2 DIABETES MELLITUS IN CLINICAL SETTINGS [Tesis doctoral no publicada]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/86209
TESIS
Bello, Ghalib. "Application and Extension of Weighted Quantile Sum Regression for the Development of a Clinical Risk Prediction Tool." VCU Scholars Compass, 2014. http://scholarscompass.vcu.edu/etd/608.
Full textAssi, Valentina. "Clinical and epidemiological issues and applications of mammographic density." Thesis, Queen Mary, University of London, 2014. http://qmro.qmul.ac.uk/xmlui/handle/123456789/7855.
Full textLouzada, Martha. "Evaluating Risk of Recurrent Venous Thromboembolism During the Anticoagulation Period in Patients with Malignancy." Thesis, Université d'Ottawa / University of Ottawa, 2011. http://hdl.handle.net/10393/19827.
Full textDiebold, Kasey Elaine. "Risk factors for wound complications following cesarean delivery." Thesis, University of Iowa, 2014. https://ir.uiowa.edu/etd/1311.
Full textEdoh, Aloysius Adotey. "A novel CMAUT-UML framework for the optimisation of Clinical Information System (CIS) and prediction of CVD percentage risk." Thesis, University of East London, 2013. http://roar.uel.ac.uk/3898/.
Full textHuang, Wei. "A Population-Based Perspective on Clinically Recognized Venous Thromboembolism: Contemporary Trends in Clinical Epidemiology and Risk Assessment of Recurrent Events: A Dissertation." eScholarship@UMMS, 2014. https://escholarship.umassmed.edu/gsbs_diss/730.
Full textHuang, Wei. "A Population-Based Perspective on Clinically Recognized Venous Thromboembolism: Contemporary Trends in Clinical Epidemiology and Risk Assessment of Recurrent Events: A Dissertation." eScholarship@UMMS, 2011. http://escholarship.umassmed.edu/gsbs_diss/730.
Full textLaimighofer, Michael [Verfasser], Fabian J. [Akademischer Betreuer] Theis, Fabian J. [Gutachter] Theis, Matthias [Gutachter] Schulze, and Claudia [Gutachter] Czado. "Statistical learning for prediction of Type 1 Diabetes using clinical risk factors and omics data / Michael Laimighofer ; Gutachter: Fabian J. Theis, Matthias Schulze, Claudia Czado ; Betreuer: Fabian J. Theis." München : Universitätsbibliothek der TU München, 2018. http://d-nb.info/1170321380/34.
Full textAlassaad, Anna. "Improving the Quality and Safety of Drug Use in Hospitalized Elderly : Assessing the Effects of Clinical Pharmacist Interventions and Identifying Patients at Risk of Drug-related Morbidity and Mortality." Doctoral thesis, Uppsala universitet, Institutionen för medicinska vetenskaper, 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-234488.
Full textReddington, John. "Re-examining educational risk prediction: The development of a parent screening inventory for children with learning difficulties at school entry." Thesis, Queensland University of Technology, 1998. https://eprints.qut.edu.au/36594/1/36594_Digitised%20Thesis.pdf.
Full textBetancourt, Marisol. "Derivation and internal validation of a clinical prediction rule to identify patients with low risk of recurrent venous thromboembolism who can discontinue oral anticoagulants after five to seven months of treatment for unprovoked venous thromboembolism." Thesis, University of Ottawa (Canada), 2007. http://hdl.handle.net/10393/27813.
Full textNorberg, Margareta. "Identifying risk of type 2 diabetes : epidemiologic perspectives from biomarkers to lifestyle." Doctoral thesis, Umeå : Umeå universitet, 2006. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-953.
Full textMarín, Lahoz Juan. "Development of a predictive model of impulse control disorder in parkinson’s disease using clinical, neuropsichological, genetic and neurophysiological data as risk markers." Doctoral thesis, Universitat Autònoma de Barcelona, 2019. http://hdl.handle.net/10803/669347.
Full textImpulse control disorders (ICD) are a common complication of Parkinson’s disease (PD) treatment, particularly of dopamine agonist (DA) use. ICD in PD have been studied for two decades. Nonetheless, prospective evidence is still scarce and predictive models are lacking. This thesis consists of four works addressing these gaps. In the first work we evaluated the association between impulsivity and incident ICD. We did not confirm the suspected association although we found a significant association between impulsivity and ICD severity (p=0.001). The lack of association between impulsivity and ICD presence was confirmed longitudinally in the fourth work. The second work was a longitudinal prospective survival study to evaluate whether the association between depression and ICD was causal. We found that depressed PD patients had approximately double risk of developing ICD (p<0.001). This association was specific and independent from DA use and other potential confounders. Besides, patients with refractory depression had an even higher risk (p=0.001). The third was a case-control study nested in a longitudinal prospective study. We studied brain metabolism via 18 FDG PET. We compared patients with new onset ICD with matched patients free of ICD from the same cohort. ICD patients showed higher metabolism in widespread cortical areas (p<0.05 FWE corrected). The results were the same using voxelwise analysis and intracortical analysis. We also showed that there were no structural differences using cortical thickness and subcortical segmentation. Using a group of matched healthy controls, we found that the higher metabolism found in ICD patients should be regarded as preservation because no cortical metabolic differences were found between PD‑ICD patients and healthy controls, while PD‑nonICD patients showed hypometabolism when compared with healthy controls. The fourth study targeted markers that could differentiate PD patients at high risk of ICD and those at low risk. Particularly we targeted the feedback related negativity (FRN) a neurophysiological marker of reward processing. We found this marker to be different in patients who developed ICD within the subsequent three years compared with those who did not (p=0.001). Furthermore, we developed two models for ICD prediction: one used only clinical data and the other also included the baseline FRN. The model including the FRN performed significantly better (p=0.003). Patients identified using the FRN as high risk had a risk ten times higher for the next three years than those identified as low risk. In conclusion, we found evidence that backs depression as a risk factor for ICD in PD, evidence of brain metabolic preservation among PD patients with ICD, evidence that supports the role of reward processing for ICD development and evidence that suggests that impulsivity should be discarded as a risk factor for ICD. Lastly, we showed that the development of ICD can be predicted in PD patients and therefore, probably can be avoided.
Shaikhina, Torgyn. "Machine learning with limited information : risk stratification and predictive modelling for clinical applications." Thesis, University of Warwick, 2017. http://wrap.warwick.ac.uk/99640/.
Full textHolland, David Christopher. "A retrospective cohort study, examining risk factors, predicting adverse clinical outcomes among pre-dialysis patients." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1998. http://www.collectionscanada.ca/obj/s4/f2/dsk2/tape17/PQDD_0002/MQ31216.pdf.
Full textBradley, India. "Clinical Practices of Neurologists Related to Predictive Testing of Presymptomatic Patients At Risk for Huntington Disease." University of Cincinnati / OhioLINK, 2014. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1406900839.
Full textSullivan, Erin. "An Examination of Risk and Resilience Factors Predicting Executive Functioning in Women following Psychological Trauma." Thesis, University of North Texas, 2019. https://digital.library.unt.edu/ark:/67531/metadc1538680/.
Full textRamaekers, Rosa. "Derivation of a Clinical Decision Tool for Predicting Adverse Outcomes Among Emergency Department Patients with Lower Gastrointestinal Bleeding." Thesis, Université d'Ottawa / University of Ottawa, 2017. http://hdl.handle.net/10393/37002.
Full textMyers, Helen. "Fall risk assessment : A prospective investigation of nurses' clinical judgement and risk assessment tools in predicting patient falls in an acute care setting." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2003. https://ro.ecu.edu.au/theses/1494.
Full textSacchetti, Gina Marie. "Predicting Risky Sexual Behaviors in College Students: A Daily Diary Study." Ohio University / OhioLINK, 2020. http://rave.ohiolink.edu/etdc/view?acc_num=ohiou1601141775519279.
Full textRice, Janice. "Assessing Suicide Risk Scores as a Predictor of Suicidal Behaviors in a Correctional Psychiatric Facility." Antioch University / OhioLINK, 2015. http://rave.ohiolink.edu/etdc/view?acc_num=antioch1438219998.
Full textBuelow, Melissa T. "The Influence of Cognitive, Personality, and Social Variables: Predicting Changes in Risky Behaviors over a Two-Year Interval." Ohio : Ohio University, 2005. http://www.ohiolink.edu/etd/view.cgi?ohiou1127142922.
Full textPaulo, António Augusto dos Santos. "Psychosocial and clinical characteristics predicting women’s acceptance of office hysteroscopy: an observational study." Doctoral thesis, Universidade de Aveiro, 2016. http://hdl.handle.net/10773/17072.
Full textA histeroscopia é hoje uma técnica imprescindível em ginecologia quer no diagnóstico de alterações genitais superiores, quer no tratamento minimamente invasivo, sendo segura, fiável e com poucos efeitos secundários e complicações. A miniaturização dos aparelhos juntamente com aperfeiçoamento técnico (nomeadamente com a abordagem vaginoscópica, sem recurso a espéculo, nem a tração do colo) vieram permitir o seu uso em consultório. Usado sem anestesia reduz os riscos do internamento e tornam o exame acessível; tem contudo a limitação da dor provocada pela instrumentação. Apesar de muitas tentativas analgésicas e anestésicas, o controlo da dor não é satisfatória em algumas doentes nas quais a histeroscopia é difícil de suportar. Este trabalho pretende estabelecer se a dor é menor com os mini histeroscópios do que com os instrumentos convencionais, avaliar quão grave é o problema da dor (quantificando a proporção de mulheres que se queixam) mesmo com este aparelhos mais delgados e tentar saber se existem fatores de risco que favoreçam a dor, ou que pelo contrário protejam a doente. Também se pretende estabelecer se os inquéritos de satisfação às doentes se correlacionam com a pontuação de dor e se a ansiedade interfere com as queixas álgicas. Finalmente também tentámos investigar se uma técnica nova de anestesia local, administrada através do histeroscópio com recurso a uma agulha cistoscópica, reduz a dor e torna o exame mais tolerável. Os resultados mostraram haver redução estatisticamente significativa da perceção da dor com mini histeroscópios em relação a aparelhos convencionais. Mostraram ainda que mesmo com calibres finos há uma proporção de doentes entre 13 e 30% que ainda refere dor moderada a severa e que reduzir o calibre abaixo dos 3,5mm pode não resultar numa redução maior da dor. Quanto a fatores de risco para a dor os nossos resultados não encontraram relação, exceto uma proteção na dor para as doentes obesas, que relacionamos com uma maior impregnação hormonal (androgénica e por via da aromatase, estrogénica). A ansiedade não parece ser importante na dor sentida, ainda que exista uma pouco significativa relação entre traço ansioso e intensidade da dor relatada. No que se refere aos questionários de satisfação, correlacionam-se muito bem com a dor reportada, tendo uma boa sensibilidade e especificidade; sendo simples de administrar e fáceis de interpretar poderiam provavelmente substituir as escalas da dor e ser úteis para eventual seleção das doentes a quem administrar a anestesia local histeroscópica. Finamente a técnica histeroscópica de injeção local de anestésico reduz significativamente a dor e poderá ser uma solução para tornar a intervenção suportável em ambulatório.
Hysteroscopy today is an essential tool in gynaecology both for diagnosis of female upper genital tract abnormalities and for minimally invasive surgery procedures. It is safe, reliable and has few side effects and complications. Diminishment of instrument diameter together with technical improvements (such as the vaginal “no touch” approach without use of speculum or cervical traction) has allowed procedures in office environment. Used without analgesia or aneasthesia it has reduced hospitalization risks and made the examination affordable; it has a drawback which is the level of pain some women refer with instrumentation. Although many attempts with the use of analgesics and anaesthetics have been made, pain control is not satisfactory in some patients for whom hysteroscopy is hard to endure. In this work we aim to establish if pain reporting is lower with mini-hysteroscopes compared to conventional scopes, how big is the problem “pain” (quantifying the proportion of women still complaining) even when using the slender mini-scopes and try to establish if there are risk factors which might influence pain reporting, or on the contrary protect, women from agony. We also explored if satisfaction questionnaires correlate well with pain scores and if patient anxiety interferes with pain. Finally we have investigated if a new local anaesthetic administration technique, with the use of a cystoscopic needle through the hysteroscope, can reduce pain and make the procedure more tolerable. Our results show there is a statistically significant reduction of pain scores when using mini-hysteroscope compared to conventional instruments. They also show that even using smaller caliber scopes there is a proportion of women varying from 13 to 30% who will still complain of moderate to severe pain and that reduction of scopes below 3.5mm diameter may not reduce pain scores any further. As to risk factors for pain, our results have not found relation to pain with risk factors except for some protection for pain in women with high body mass index, and we relate this finding with elevated circulating hormones (androgens which are peripherally converted to estrogens via aromatase in adipose tissue). Anxiety does not seem important in pain reporting, even if a slight statistical significance was found between anxiety trait and pain reporting. As to satisfaction questionnaires, they seem to correlate well with the pain experience and show and excellent sensitivity and specificity: simple to administer and easy to interpret, they could probably replace more complicated pain rating scales and be useful in selecting women who would benefit from local anaesthesia. Finally as to the new technique of applying local anaesthetics “hysteroscopic anaesthesia”, results show a statistical reduction of pain after injection and it could become a practical solution in making hysteroscopy bearable in an office setting.
Riley, Elizabeth N. "THE RECIPROCAL PREDICTIVE RELATIONSHIP BETWEEN PERSONALITY AND RISKY BEHAVIORS: AN 8-WAVE LONGITUDINAL STUDY IN EARLY ADOLESCENTS." UKnowledge, 2015. http://uknowledge.uky.edu/psychology_etds/67.
Full textFrendl, Daniel M. "Predicting Other Cause Mortality Risk for Older Men with Localized Prostate Cancer: A Dissertation." eScholarship@UMMS, 2015. https://escholarship.umassmed.edu/gsbs_diss/772.
Full textSancho, Mestre Carla. "MODELO PREDICTIVO DE AJUSTE DE RIESGO Y COSTES EN PACIENTES CON DIABETES MELLITUS EN LA COMUNIDAD VALENCIANA." Doctoral thesis, Universitat Politècnica de València, 2017. http://hdl.handle.net/10251/83483.
Full textOBJETIVO Determinación de la prevalencia y análisis de las características de la población, perfil de morbilidad, multimorbilidad, costes farmacéuticos, consumo de recursos y complicaciones de los pacientes con Diabetes mellitus (DM2) en la Comunidad Valenciana. Con ello, se pretende establecer un modelo de predicción del consumo de recursos de los pacientes con Diabetes mellitus tipo 2 (DM 2). DISEÑO DEL ESTUDIO Metodología Estudio observacional, descriptivo, retrospectivo y de corte transversal. Se elabora una base de datos con los pacientes diagnosticados de DM2 en la Comunidad Valenciana en el año 2012 y se clasifica a los mismos por estados de salud, utilizando el sistema Clinical Risk Groups (CRG). Se analizan las comorbilidades y complicaciones específicas asociadas a la enfermedad así como el gasto farmacéutico. Este se analiza desde diferentes puntos de vista: comorbilidades, estados de salud CRG y fármacos utilizados para el tratamiento de la enfermedad. Con todo ello, se plantea modelos de regresión multivariante para predecir el gasto farmacéutico en función de las diferentes variables disponibles en los que la variable dependiente es el gasto farmacéutico total por paciente y año y las variables explicativas se seleccionarán, de entre las disponibles en la base de datos elaborada. Finalmente, se presenta un análisis factorial y de componentes principales para estudiar diferencias entre los pacientes diabéticos analizados, en cuanto a gasto farmacéutico. Población de estudio Población con diagnóstico de diabetes tipo 2 de la Comunidad Valenciana en el 2012. De los 491.854 pacientes con diagnóstico de diabetes, se excluyen todos aquellos pacientes con diabetes juvenil, diabetes gestacional y los que no recibieron tratamiento farmacológico, reduciendo el grupo a 350.015 pacientes. Fuentes de información y variables de estudio Las fuentes fundamentales para la obtención de los datos: -La historia clínica electrónica, ABUCASIS. -El módulo de prestación farmacéutica, GAIA. -El Conjunto Mínimo Básico de Datos, CMBD. -El catálogo de recursos corporativos, CRC. -Sistema de Información Poblacional, SIP. -Los Grupos de Riesgo Clínico (Clinical Risk Groups, CRGs). Limitaciones del estudio 1.Estado de la codificación de los diagnósticos, tanto en términos cuantitativos como cualitativos. 2. Desequilibrio en la utilización de los sistemas de información ambulatorios corporativos con posibilidad de clasificaciones erróneas (SIA-GAIA). RESULTADOS La prevalencia bruta estimada de la diabetes fue del 7,72%, con un consumo medio por paciente y año de cerca de 1.330€. Por estados de salud, cerca de 48% de los pacientes se clasifican en el estado de salud 6. En cuanto a las comorbilidades de los pacientes con DM2, el 68% sufren además hipertensión y un 53% dislipemia. El gasto farmacéutico aumenta con la presencia de comorbilidades (de 592€ a 3.825€ anuales por paciente, con una comorbilidad a seis y más, respectivamente)., el estado de salud CRG y la severidad del paciente; y con edades más avanzadas. Por tipo de fármaco, el consumo varía entre importes anuales inferiores a 50€ hasta cifras que superan los 600€. Un modelo de regresión lineal multivariante que considera el estado de salud y severidad del paciente alcanza un coeficiente de determinación corregido¿R2 de un 39,3% de la variabilidad. Finalmente, el análisis factorial identifica 6 factores que explican el 49,3% de la varianza en el consumo anual farmacéutico de los pacientes diabéticos. CONCLUSIONES La diabetes presenta una elevada prevalencia y se caracteriza por la coexistencia de otras enfermedades, lo cual conlleva incrementos considerables en el coste del tratamiento. El consumo por paciente aumenta con el empeoramiento del estado de salud del paciente y la edad más avanzada, así como por el tipo de tratamiento farmacológico del paciente. La r
OBJECTIU Determinació de la prevalença i anàlisi de les característiques de la població, perfil de morbiditat, multimorbilitat, costos farmacèutics, consum de recursos i complicacions dels pacients amb Diabetis Mellitus (DM2) a la Comunitat Valenciana (CV). Es pretén establir un model de predicció del Consum de recursos dels Pacients amb Diabetis Mellitus tipus II (DM 2). DISSENY DE L'ESTUDI Metodologia Estudi observacional, descriptiu, retrospectiu i de tall transversal. En primer s'elabora una base de dades amb els pacients amb diagnòstic de DM2 a la Comunitat Valenciana en l'any 2012 i es classifica als pacients per estats de salut, utilitzant del sistema de Grups de Risc Clínic (CRG). S'analitzen les comorbiditats i complicacions associades a la infermetat, així com la despesa farmacèutica des de diferents perspectives: comorbiditats, estats de salut i fàrmacs utilitzats per al tractament de la malaltia. Es plantegen models de regressió multivariant per predir la despesa farmacèutica en funció de les diferents variables disponibles. La variable dependent es la despesa farmacèutica total per pacient i any, i les variables explicatives es seleccionaran, d'entre les disponibles a la base de dades elaborada. Finalment, a la tesi, es presenta l'anàlisi factorial i de components principals que ens permet estudiar les diferències entre els pacients diabètics analitzats, des del punt de vista de la despesa farmacèutica, comorbiditats relacionades i no relacionades amb la DM2 i complicacions. Població d'estudi Població amb Diagnòstic de diabetis (DM 2) de la Comunitat Valenciana en l'any 2012. Dels 491.854 pacients amb diagnòstic de la diabetis, s'exclouen de els pacients amb diabetis juvenil, diabetis gestacional i els que no van rebre tractament farmacològic, reduint el grup a 350.015. Fonts d'Informació i variables d'estudi - La història clínica electrònica, ABUCASIS. - El mòdul de prestació farmacèutica, GAIA. - El Conjunt Mínim de Dades Bàsiques, CMBD. - El catàleg de recursos corporatius, CRC. - Sistema d'Informació Poblacional, SIP. - Els Grups de Risc Clínic (grups de risc clínics, CRGs). Limitacions de l'estudi 1. Estat de codificació dels diagnòstics, tant en termes quantitatius com qualitatius. 2. Desequilibri en la utilització dels sistemes d'informació corporatius ambulatoris amb possibilitat de classificació. RESULTATS La prevalença bruta estimada de la diabetis va ser del 7,72, i el consum mitjà per pacient i any de uns 1.330€. Per estats de salut, prop de 48% dels pacients es classifiquen en l'estat de salut 6, i al voltant del 29% en el 5. En quant a les comorbiditats dels Pacients amb DM2, el 68% pateixen hipertensió, i un 53% dislipèmia. La despesa augmenta amb la presencia de comorbiditats (de 592 € a 3.825 € per pacient anualment, amb una comorbiditat i amb una sis i més, respectivament), així com amb l'estat de salut del CRG i la severitat del pacient. Per tipus de fàrmac, el consum és més baix en biguanides i sulfonilurees, amb imports anuals inferiors a 50 € fins a més de 600€ en el cas de combinacions. Es plantegen models per predicció del consum farmacèutic ambulatori de pacients diabètics del tipus 2, proposant com a resultat un model de regressió lineal multivariant que considera l'estat de salut i severitat del pacient segons el sistema CRG. D'altra banda, l'anàlisi factorial identifica 6 factors que expliquen de l'49,3% de la variància a el consum anuals farmacèutic dels pacients. CONCLUSIONS La diabetis presenta una elevada prevalença i es caracteritza per la coexistència d'altres malalties, la qual cosa comporta increments considerables en el cost del tractament i complica la gestió de la malaltia. El consum per pacient augmenta amb l'empitjorament de l'estat de salut del pacient i l'edat avançada, i a més també ve determinat pel tipus de tractament farmacològic que segueixen e
Sancho Mestre, C. (2017). MODELO PREDICTIVO DE AJUSTE DE RIESGO Y COSTES EN PACIENTES CON DIABETES MELLITUS EN LA COMUNIDAD VALENCIANA [Tesis doctoral no publicada]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/83483
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