A. Illness Pathway: Illness determinants
|
Group
|
Subgroup
|
Examples
|
Person-related | Population characteristics | Age, sex, and ethnicity structures |
Person-related | Biological | Levels of raised blood pressure, obesity, adverse lipid profiles, genetic predispositions |
Person-related | Behavioural | Patterns across populations in diet, physical activity, smoking behaviour, alcohol consumption, health literacy and self-sufficiency, illicit substance use, and engagement with systems |
Disease-related | Disease mechanisms | Infections, external injuries, developmental abnormalities, genetic susceptibilities, autoimmune defects, and cellular degeneration |
Disease-related | Epidemiology | Prevalence, natural history, and distribution in populations |
B. Illness Pathway: Health needs
|
Group
|
Subgroup with examples
|
Manifestations of illness | 1. Levels of morbidity (for example, disease prevalence in given populations) 2. Prevalence and types of clinical features (for example, physical or psychological) |
Disruptions to functioning (in those with disease) | 1. Physical (for example, activities of daily living, such as mobility, feeding, continence, or dressing) 2. Psychological (for example, scores on tools measuring anxiety and depression, or dementia) 3. Socioeconomic (changes in roles, for example, job, relationships, and in activities, for example, driving, sports) |
C. Illness Pathway: Health outcomes
|
Group
|
Subgroup
|
Examples
|
Significant events | Complication | 1. Death (for example, disease-specific rates, rates by population characteristic) 2. Non-fatal (for example, rates of non-fatal myocardial infarction, diabetes-related limb loss, or exacerbation of chronic obstructive pulmonary disease) |
Significant events | Transfer of care | 1. Hospital admission rates (emergency or planned), 2. Referrals to secondary care (rates or types) 3. Discharge rates between units or into the community |
Altered health status levels | Physical/psychological | Population rates of disability-adjusted life years |
Altered health status levels | Socioeconomic | Rates of unemployment or of disability benefit claims |
Resolution | Cure | Rates of disease eradication |
Resolution | Remission | Rates of those with inactive disease, but not confirmed as eradicated |
D. Modifiers: Context
|
Group
|
Subgroups with examples
|
Physical | 1. Geography (for example, urban versus rural) 2. Housing (including homelessness) 3. Transport 4. Facilities 5. Water supply and sanitation 6. Exposure to crime 7. Exposure to pollution |
Socioeconomic | 1. Public and private policies (for example, governmental at different levels) 2. Expenditure on social welfare and education 3. Social networks (relationships, families, carers, or other support) 4. Education (including linguistic and numerical literacy) 5. Employment 6. Fiscal (for example, income and expenditure) |
E. Modifiers: Interventions
|
Group
|
Subgroup
|
Specific areas with examples
|
Structures | Governance | 1. Policies at government, local, and organisational levels 2. Regulations: legal, organisational, and professional |
Structures | Resources | 1. Financial (expenditure, allocation, or remuneration/incentives) 2. Human (numbers, distribution and characteristics; for example, skill sets) 3. Material (for example, physical infrastructure or IT systems) |
Processes | Access | 1. Physical and organisational distribution (for example, optimising choice and availability of place of care between home, or community and institution) 2. Appointment systems (for example, flexibility or timing) 3. Candidacy (targeting best care to all those with the potential to benefit) |
Processes | Range of work | 1. Anticipatory care (prevention plus early detection) 2. Acute care 3. Management of long term conditions (for example, coronary heart disease, stroke, COPD, thyroid, or chronic severe mental illness) |
Processes | Coordination | 1. Teamwork 2. Pathways to other healthcare providers, other care (for example, social) networks, and with public health systems |
Processes | Continuity and choice of care | 1. Balance between long-term relationship with usual provider, if preferred, and freedom to choose provider 2. Management (access to effective IT systems with appointments, medical records, medical prescribing, communications within and outside, or financial/contractual data) |