Four groups of non-communicable diseases in outpatient health care: analysis of data from medical information systems

The World Health Organization suggested the concept of four main groups of non-communicable diseases (NCDs) for development of programs for prevention and decreasing mortality. Objective: to assess the opportunities and challenges of using health information systems (MIS) to account for four groups of NCDs in outpatient healthcare. Materials and methods: Personalized anonymized data on the deceased who applied for any reason to outpatient clinics in the Moscow region a year before death. The analysis included 4 groups of NCDs: malignant neoplasms (MN, C 0-96), diseases of the circulatory system (DCS, I00-I99), chronic obstructive pulmonary disease (COPD, J44), diabetes mellitus (DM, E10-14). Results: A combination of any two of the analyzed groups of diseases was presented in 17.5%, three - in 2.2%, four - in 0.07% of patients; one of the 4 groups was registered in 48.1% patients, DCS – in 59.8%, (hypertension – 38.6%, ischemic heart disease -20.1%); cancer – in 15.9%, DM - 12.2%, COPD - 2.1%.  NCDs from four groups were registered in 67.9% patients a year before death, but the cause of death from above diseases was registered in only half of them. Patients with NCDs sought medical help more often than patients without the disease (p<0.001). The maximum number of visits (38.5±16.2) was registered in patients (average age 70.6±7.7) who had all four groups of NCDs. On average, 4.9±4.3 diseases (ICD-10 codes) were registered per patient, which indirectly indicates multimorbidity. Conclusion. Every third outpatient in the year before death did not have any of the four analyzed NCDs; DCS were registered most often, which should be taken into account in process of creating clinical recommendations. MIS make it possible to determine the frequency and combinations of diseases, demographic characteristics of patients, and the number of visits.  MIS can replace registries to solve some clinical problems, but the lack of clear rules for entering significant entities (eg, heart failure, atrial fibrillation) limits their use.