Four groups of noncommunicable diseases in outpatient health care: analysis of medical information system data

BACKGROUND: The World Health Organization uses the concept of four major groups of noncommunicable diseases, which are associated with high mortality rates, to inform prevention and mortality reduction strategies.

AIM: To evaluate the capabilities and limitations of using medical information systems to monitor the four major noncommunicable diseases groups in outpatient health care.

MATERIALS AND METHODS: Depersonalized individual-level data were collected for 86 266 deceased individuals who had sought care for any reason at public outpatient clinics in the Moscow region during the year preceding death. The analysis included four groups of noncommunicable diseases: malignant neoplasms, cardiovascular diseases (ICD-10 codes I00–I99), chronic obstructive pulmonary disease, and diabetes mellitus. Laboratory and instrumental tests, as well as medical interventions, were not performed or analyzed. Statistical analyses were performed using SPSS, version 26.0 (IBM Corp) and Microsoft Excel (Microsoft Corp).

RESULTS: A combination of any two of the four analyzed noncommunicable diseases groups was identified in 17.5% of patients; three groups in 2.2%; and all four groups in 0.07%. A single noncommunicable diseases group was recorded in 48.1% of cases. Circulatory system diseases were present in 59.8% of patients, including hypertension in 38.6% and coronary artery disease in 20.1%. Malignant neoplasms were diagnosed in 15.9%, diabetes mellitus in 12.2%, and chronic obstructive pulmonary disease in 2.1%. Within the year preceding death, 67.9% of patients had at least one diagnosis from the four major noncommunicable diseases groups; however, in only half of these cases were these diagnostic categories listed as the underlying cause of death. Patients with any of the four noncommunicable diseases had significantly more frequent outpatient visits compared with those without such conditions (p <0.001). The highest number of visits (38.5±16.2) was observed in patients (mean age, 70.6±7.7 years) with diagnoses from all four noncommunicable diseases groups. On average, 4.9±4.3 ICD-10 codes were recorded per patient, indirectly indicating the presence of multimorbidity.

CONCLUSION: One in three outpatients had no diagnoses from the four analyzed noncommunicable diseases groups in the year preceding death. Circulatory system diseases were the most frequently recorded and should be prioritized in the development of clinical guidelines. Medical information systems have the potential to serve as alternatives to disease registries in addressing clinical challenges; however, the absence of standardized protocols for recording clinically significant conditions (e.g., heart failure, atrial fibrillation) limits their practical utility.