{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,3,27]],"date-time":"2025-03-27T08:28:19Z","timestamp":1743064099142,"version":"3.37.3"},"reference-count":48,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2019,11,21]],"date-time":"2019-11-21T00:00:00Z","timestamp":1574294400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2019,11,21]],"date-time":"2019-11-21T00:00:00Z","timestamp":1574294400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Med Inform Decis Mak"],"published-print":{"date-parts":[[2019,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n<jats:title>Background<\/jats:title>\n<jats:p>Demographic changes, increased life expectancy and the associated rise in chronic diseases pose challenges to public health care systems. Optimized treatment methods and integrated concepts of care are potential solutions to overcome increasing financial burdens and improve quality of care. In this context modeling is a powerful tool to evaluate potential benefits of different treatment procedures on health outcomes as well as health care budgets. This work presents a novel modeling approach for simulating different treatment procedures of heart failure patients based on extensive data sets from outpatient and inpatient care.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>Our hybrid heart failure model is based on discrete event and agent based methodologies and facilitates the incorporation of different therapeutic procedures for outpatient and inpatient care on patient individual level. The state of health is modeled with the functional classification of the New York Heart Association (NYHA), strongly affecting discrete state transition probabilities alongside age and gender. Cooperation with Austrian health care and health insurance providers allowed the realization of a detailed model structure based on clinical data of more than 25,000 patients.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>Simulation results of conventional care and a telemonitoring program underline the unfavorable prognosis for heart failure and reveal the correlation of NYHA classes with health and economic outcomes. Average expenses for the treatment of NYHA class IV patients of \u20ac10,077\u2009\u00b1\u2009\u20ac165 were more than doubled compared to other classes. The selected use case of a telemonitoring program demonstrated potential cost savings within two years of application. NYHA classes II and III revealed most potential for additional treatment measures.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Conclusion<\/jats:title>\n<jats:p>The presented model allows performing extensive simulations of established treatment procedures for heart failure patients and evaluating new holistic methods of care and innovative study designs. This approach offers health care providers a unique, adaptable and comprehensive tool for decision making in the complex and socioeconomically challenging field of cardiovascular diseases.<\/jats:p>\n<\/jats:sec>","DOI":"10.1186\/s12911-019-0944-3","type":"journal-article","created":{"date-parts":[[2019,11,21]],"date-time":"2019-11-21T10:03:56Z","timestamp":1574330636000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["A novel hybrid modeling approach for the evaluation of integrated care and economic outcome in heart failure treatment"],"prefix":"10.1186","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0918-4550","authenticated-orcid":false,"given":"Alexander","family":"Lassnig","sequence":"first","affiliation":[]},{"given":"Theresa","family":"Rienmueller","sequence":"additional","affiliation":[]},{"given":"Diether","family":"Kramer","sequence":"additional","affiliation":[]},{"given":"Werner","family":"Leodolter","sequence":"additional","affiliation":[]},{"given":"Christian","family":"Baumgartner","sequence":"additional","affiliation":[]},{"given":"Joerg","family":"Schroettner","sequence":"additional","affiliation":[]}],"member":"297","published-online":{"date-parts":[[2019,11,21]]},"reference":[{"key":"944_CR1","doi-asserted-by":"publisher","first-page":"201","DOI":"10.1111\/j.1475-6773.2006.00607.x","volume":"42","author":"EM Martini","year":"2007","unstructured":"Martini EM, Garrett N, Lindquist T, Isham GJ. The boomers are coming: a Total cost of care model of the impact of population aging on health care costs in the United States by major practice category. Health Serv Res. 2007;42:201\u201318.","journal-title":"Health Serv Res"},{"key":"944_CR2","unstructured":"European Union, editor. People in the EU: who are we and how do we live? : 2015 edition. 2015th ed. Luxembourg: Publications Office; 2015."},{"key":"944_CR3","unstructured":"National Academies Press (US). Aging and the Macroeconomy: Long-Term Implications of an Older Population. Washington (DC); 2012."},{"key":"944_CR4","doi-asserted-by":"publisher","first-page":"799","DOI":"10.1161\/CIRCULATIONAHA.104.492033","volume":"113","author":"WH Barker","year":"2006","unstructured":"Barker WH, Mullooly JP, Getchell W. Changing incidence and survival for heart failure in a well-defined older population, 1970-1974 and 1990-1994. Circulation. 2006;113:799\u2013805.","journal-title":"Circulation."},{"key":"944_CR5","doi-asserted-by":"publisher","first-page":"2057","DOI":"10.1161\/CIRCULATIONAHA.108.784215","volume":"118","author":"RS Velagaleti","year":"2008","unstructured":"Velagaleti RS, Pencina MJ, Murabito JM, Wang TJ, Parikh NI, D'Agostino RB, et al. Long-term trends in the incidence of heart failure after myocardial infarction. Circulation. 2008;118:2057\u201362.","journal-title":"Circulation."},{"issue":"Suppl 5","key":"944_CR6","doi-asserted-by":"publisher","first-page":"v1","DOI":"10.1093\/europace\/eup304","volume":"11","author":"F Zannad","year":"2009","unstructured":"Zannad F, Agrinier N, Alla F. Heart failure burden and therapy. Europace. 2009;11(Suppl 5):v1\u20139.","journal-title":"Europace."},{"key":"944_CR7","doi-asserted-by":"publisher","first-page":"606","DOI":"10.1161\/HHF.0b013e318291329a","volume":"6","author":"PA Heidenreich","year":"2013","unstructured":"Heidenreich PA, Albert NM, Allen LA, Bluemke DA, Butler J, Fonarow GC, et al. Forecasting the impact of heart failure in the United States: a policy statement from the American Heart Association. Circ Heart Fail. 2013;6:606\u201319.","journal-title":"Circ Heart Fail."},{"key":"944_CR8","doi-asserted-by":"publisher","first-page":"1510","DOI":"10.1016\/j.jacc.2013.01.022","volume":"61","author":"MD Huffman","year":"2013","unstructured":"Huffman MD, Berry JD, Ning H, Dyer AR, Garside DB, Cai X, et al. Lifetime risk for heart failure among white and black Americans: cardiovascular lifetime risk pooling project. J Am Coll Cardiol. 2013;61:1510\u20137.","journal-title":"J Am Coll Cardiol"},{"key":"944_CR9","doi-asserted-by":"publisher","first-page":"283","DOI":"10.1016\/S1388-9842(01)00123-4","volume":"3","author":"C Berry","year":"2001","unstructured":"Berry C, Murdoch DR, McMurray JJ. Economics of chronic heart failure. Eur J Heart Fail. 2001;3:283\u201391.","journal-title":"Eur J Heart Fail"},{"key":"944_CR10","first-page":"e46","volume":"121","author":"D Lloyd-Jones","year":"2010","unstructured":"Lloyd-Jones D, Adams RJ, Brown TM, Carnethon M, Dai S, de Simone G, et al. Heart disease and stroke statistics--2010 update: a report from the American Heart Association. Circulation. 2010;121:e46\u2013e215.","journal-title":"Circulation."},{"key":"944_CR11","doi-asserted-by":"publisher","first-page":"361","DOI":"10.1016\/S1388-9842(01)00198-2","volume":"4","author":"S Stewart","year":"2002","unstructured":"Stewart S, Jenkins A, Buchan S, McGuire A, Capewell S, McMurray JJJV. The current cost of heart failure to the National Health Service in the UK. Eur J Heart Fail. 2002;4:361\u201371.","journal-title":"Eur J Heart Fail"},{"key":"944_CR12","doi-asserted-by":"publisher","first-page":"480","DOI":"10.1161\/CIRCULATIONAHA.108.191259","volume":"119","author":"D Lloyd-Jones","year":"2009","unstructured":"Lloyd-Jones D, Adams R, Carnethon M, de Simone G, Ferguson TB, Flegal K, et al. Heart disease and stroke statistics--2009 update: a report from the American Heart Association statistics committee and stroke statistics subcommittee. Circulation. 2009;119:480\u20136.","journal-title":"Circulation."},{"key":"944_CR13","doi-asserted-by":"publisher","first-page":"344","DOI":"10.1001\/jama.292.3.344","volume":"292","author":"VL Roger","year":"2004","unstructured":"Roger VL, Weston SA, Redfield MM, Hellermann-Homan JP, Killian J, Yawn BP, Jacobsen SJ. Trends in heart failure incidence and survival in a community-based population. JAMA. 2004;292:344\u201350.","journal-title":"JAMA."},{"key":"944_CR14","doi-asserted-by":"publisher","first-page":"996","DOI":"10.1001\/jamainternmed.2015.0924","volume":"175","author":"Y Gerber","year":"2015","unstructured":"Gerber Y, Weston SA, Redfield MM, Chamberlain AM, Manemann SM, Jiang R, et al. A contemporary appraisal of the heart failure epidemic in Olmsted County, Minnesota, 2000 to 2010. JAMA Intern Med. 2015;175:996\u20131004.","journal-title":"JAMA Intern Med"},{"key":"944_CR15","doi-asserted-by":"publisher","first-page":"504","DOI":"10.1016\/j.amjcard.2013.10.032","volume":"113","author":"PP Chang","year":"2014","unstructured":"Chang PP, Chambless LE, Shahar E, Bertoni AG, Russell SD, Ni H, et al. Incidence and survival of hospitalized acute decompensated heart failure in four US communities (from the atherosclerosis risk in communities study). Am J Cardiol. 2014;113:504\u201310.","journal-title":"Am J Cardiol"},{"key":"944_CR16","doi-asserted-by":"publisher","first-page":"1016","DOI":"10.1016\/j.amjcard.2007.11.061","volume":"101","author":"LR Loehr","year":"2008","unstructured":"Loehr LR, Rosamond WD, Chang PP, Folsom AR, Chambless LE. Heart failure incidence and survival (from the atherosclerosis risk in communities study). Am J Cardiol. 2008;101:1016\u201322.","journal-title":"Am J Cardiol"},{"key":"944_CR17","doi-asserted-by":"publisher","first-page":"1669","DOI":"10.1001\/jama.2011.1474","volume":"306","author":"J Chen","year":"2011","unstructured":"Chen J, Normand S-LT, Wang Y, Krumholz HM. National and regional trends in heart failure hospitalization and mortality rates for Medicare beneficiaries, 1998-2008. JAMA. 2011;306:1669\u201378.","journal-title":"JAMA."},{"key":"944_CR18","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1161\/CIRCHEARTFAILURE.109.885210","volume":"3","author":"JS Ross","year":"2010","unstructured":"Ross JS, Chen J, Lin Z, Bueno H, Curtis JP, Keenan PS, et al. Recent national trends in readmission rates after heart failure hospitalization. Circ Heart Fail. 2010;3:97\u2013103.","journal-title":"Circ Heart Fail"},{"key":"944_CR19","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1161\/CIRCOUTCOMES.110.950964","volume":"4","author":"KE Joynt","year":"2011","unstructured":"Joynt KE, Jha AK. Who has higher readmission rates for heart failure, and why? Implications for efforts to improve care using financial incentives. Circ Cardiovasc Qual Outcomes. 2011;4:53\u20139.","journal-title":"Circ Cardiovasc Qual Outcomes"},{"key":"944_CR20","doi-asserted-by":"publisher","first-page":"414","DOI":"10.1161\/CIRCHEARTFAILURE.111.964791","volume":"5","author":"S Chun","year":"2012","unstructured":"Chun S, Tu JV, Wijeysundera HC, Austin PC, Wang X, Levy D, Lee DS. Lifetime analysis of hospitalizations and survival of patients newly admitted with heart failure. Circ Heart Fail. 2012;5:414\u201321.","journal-title":"Circ Heart Fail."},{"key":"944_CR21","doi-asserted-by":"publisher","first-page":"E1124","DOI":"10.1503\/cmaj.180290","volume":"190","author":"A Gruneir","year":"2018","unstructured":"Gruneir A, Fung K, Fischer HD, Bronskill SE, Panjwani D, Bell CM, et al. Care setting and 30-day hospital readmissions among older adults: a population-based cohort study. CMAJ. 2018;190:E1124\u201333.","journal-title":"CMAJ."},{"key":"944_CR22","doi-asserted-by":"publisher","first-page":"734","DOI":"10.1007\/s00508-014-0665-7","volume":"126","author":"A von der Heidt","year":"2014","unstructured":"von der Heidt A, Ammenwerth E, Bauer K, Fetz B, Fluckinger T, Gassner A, et al. HerzMobil Tirol network: rationale for and design of a collaborative heart failure disease management program in Austria. Wien Klin Wochenschr. 2014;126:734\u201341.","journal-title":"Wien Klin Wochenschr"},{"key":"944_CR23","doi-asserted-by":"publisher","first-page":"1873","DOI":"10.1161\/CIRCULATIONAHA.111.018473","volume":"123","author":"F Koehler","year":"2011","unstructured":"Koehler F, Winkler S, Schieber M, Sechtem U, Stangl K, B\u00f6hm M, et al. Impact of remote telemedical management on mortality and hospitalizations in ambulatory patients with chronic heart failure: the telemedical interventional monitoring in heart failure study. Circulation. 2011;123:1873\u201380.","journal-title":"Circulation."},{"key":"944_CR24","doi-asserted-by":"publisher","first-page":"610","DOI":"10.1016\/j.ijnurstu.2011.11.002","volume":"49","author":"E Lambrinou","year":"2012","unstructured":"Lambrinou E, Kalogirou F, Lamnisos D, Sourtzi P. Effectiveness of heart failure management programmes with nurse-led discharge planning in reducing re-admissions: a systematic review and meta-analysis. Int J Nurs Stud. 2012;49:610\u201324.","journal-title":"Int J Nurs Stud"},{"key":"944_CR25","doi-asserted-by":"publisher","first-page":"e011952","DOI":"10.1136\/bmjopen-2016-011952","volume":"6","author":"S Damery","year":"2016","unstructured":"Damery S, Flanagan S, Combes G. Does integrated care reduce hospital activity for patients with chronic diseases? An umbrella review of systematic reviews. BMJ Open. 2016;6:e011952.","journal-title":"BMJ Open"},{"key":"944_CR26","doi-asserted-by":"publisher","first-page":"774","DOI":"10.7326\/M14-0083","volume":"160","author":"C Feltner","year":"2014","unstructured":"Feltner C, Jones CD, Cen\u00e9 CW, Zheng Z-J, Sueta CA, Coker-Schwimmer EJL, et al. Transitional care interventions to prevent readmissions for persons with heart failure: a systematic review and meta-analysis. Ann Intern Med. 2014;160:774\u201384.","journal-title":"Ann Intern Med"},{"key":"944_CR27","doi-asserted-by":"publisher","first-page":"900","DOI":"10.1016\/j.recesp.2016.05.008","volume":"69","author":"J Oyanguren","year":"2016","unstructured":"Oyanguren J, Latorre Garc\u00eda PM, Torcal Laguna J, Lekuona Goya I, Rubio Mart\u00edn S, Maull Lafuente E, Grandes G. Effectiveness and Factors Determining the Success of Management Programs for Patients With Heart Failure: A Systematic Review and Meta-analysis. Rev Esp Cardiol (Engl Ed). 2016;69:900\u201314.","journal-title":"Rev Esp Cardiol (Engl Ed)"},{"key":"944_CR28","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1186\/2191-1991-3-26","volume":"3","author":"J Schroettner","year":"2013","unstructured":"Schroettner J, Lassnig A. Simulation model for cost estimation of integrated care concepts of heart failure patients. Health Econ Rev. 2013;3:26.","journal-title":"Health Econ Rev"},{"volume-title":"Nomenclature and criteria for diagnosis of diseases of the heart and great vessels. 9th ed","year":"1994","key":"944_CR29","unstructured":"The Criteria Committee of the New York Heart Association, editor. Nomenclature and criteria for diagnosis of diseases of the heart and great vessels. 9th ed. Boston: Mass.: Little Brown and Co; 1994."},{"key":"944_CR30","unstructured":"Nelson ME. Electrophysiological Models. In: Databasing the brain. From data to knowledge (neuroinformatics). p. 286\u2013302."},{"key":"944_CR31","unstructured":"Arzneimittelkommission der deutschen \u00c4rzteschaft, editor. Empfehlungen zur Therapie der chronischen Herzinsuffizienz; 2007."},{"key":"944_CR32","doi-asserted-by":"publisher","first-page":"323","DOI":"10.1016\/j.ijcard.2012.01.099","volume":"156","author":"J Biermann","year":"2012","unstructured":"Biermann J, Neumann T, Angermann CE, Erbel R, Maisch B, Pittrow D, et al. Economic burden of patients with various etiologies of chronic systolic heart failure analyzed by resource use and costs. Int J Cardiol. 2012;156:323\u20135.","journal-title":"Int J Cardiol"},{"key":"944_CR33","doi-asserted-by":"publisher","first-page":"619","DOI":"10.1080\/15598608.2013.824823","volume":"8","author":"JC Gardiner","year":"2014","unstructured":"Gardiner JC, Luo Z, Tang X, Ramamoorthi RV. Fitting heavy-tailed distributions to health care data by parametric and Bayesian methods. J Stat Theory Practice. 2014;8:619\u201352.","journal-title":"J Stat Theory Practice"},{"key":"944_CR34","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1186\/s13561-015-0045-7","volume":"5","author":"AS Malehi","year":"2015","unstructured":"Malehi AS, Pourmotahari F, Angali KA. Statistical models for the analysis of skewed healthcare cost data: a simulation study. Health Econ Rev. 2015;5:11.","journal-title":"Health Econ Rev"},{"key":"944_CR35","unstructured":"Gerste B, G\u00fcnster C, G\u00fcnther H, Steffen H. Sektor\u00fcbergreifende Leistungsanalysen: Inanspruchnahme von Gesundheitsleistungen durch Patienten mit koronarer Herzkrankheit oder Herzinsuffizienz: Wissenschaftliches Institut der AOK (WIdO); 2007."},{"key":"944_CR36","unstructured":"Embacher G, Batrosik W, Brosch P, Fritz G, Iskra S, Sebek W, et al. Leistungsorientierte Krankenanstaltenfinanzierung - LKF - Modell 2018: Bundesministerium f\u00fcr Gesundheit und Frauen; 2017."},{"key":"944_CR37","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1186\/s13054-015-0813-0","volume":"19","author":"J-L Vincent","year":"2015","unstructured":"Vincent J-L, Rubenfeld GD. Does intermediate care improve patient outcomes or reduce costs? Crit Care. 2015;19:89.","journal-title":"Crit Care"},{"key":"944_CR38","doi-asserted-by":"publisher","first-page":"333","DOI":"10.1093\/eurjhf\/hfr144","volume":"14","author":"P Dendale","year":"2012","unstructured":"Dendale P, de Keulenaer G, Troisfontaines P, Weytjens C, Mullens W, Elegeert I, et al. Effect of a telemonitoring-facilitated collaboration between general practitioner and heart failure clinic on mortality and rehospitalization rates in severe heart failure: the TEMA-HF 1 (TElemonitoring in the MAnagement of heart failure) study. Eur J Heart Fail. 2012;14:333\u201340.","journal-title":"Eur J Heart Fail"},{"key":"944_CR39","doi-asserted-by":"publisher","first-page":"753","DOI":"10.2165\/11585990-000000000-00000","volume":"29","author":"A Goehler","year":"2011","unstructured":"Goehler A, Geisler BP, Manne JM, Jahn B, Conrads-Frank A, Schnell-Inderst P, et al. Decision-analytic models to simulate health outcomes and costs in heart failure: a systematic review. Pharmacoeconomics. 2011;29:753\u201369.","journal-title":"Pharmacoeconomics."},{"key":"944_CR40","doi-asserted-by":"publisher","first-page":"1424","DOI":"10.1161\/CIRCULATIONAHA.105.584102","volume":"113","author":"WC Levy","year":"2006","unstructured":"Levy WC, Mozaffarian D, Linker DT, Sutradhar SC, Anker SD, Cropp AB, et al. The Seattle heart failure model: prediction of survival in heart failure. Circulation. 2006;113:1424\u201333.","journal-title":"Circulation."},{"key":"944_CR41","doi-asserted-by":"publisher","first-page":"e0179176","DOI":"10.1371\/journal.pone.0179176","volume":"12","author":"F Gasperoni","year":"2017","unstructured":"Gasperoni F, Ieva F, Barbati G, Scagnetto A, Iorio A, Sinagra G, Di Lenarda A. Multi-state modelling of heart failure care path: a population-based investigation from Italy. PLoS One. 2017;12:e0179176.","journal-title":"PLoS One"},{"key":"944_CR42","doi-asserted-by":"publisher","first-page":"131","DOI":"10.1007\/s10741-017-9661-0","volume":"23","author":"AA Shafie","year":"2018","unstructured":"Shafie AA, Tan YP, Ng CH. Systematic review of economic burden of heart failure. Heart Fail Rev. 2018;23:131\u201345.","journal-title":"Heart Fail Rev"},{"key":"944_CR43","doi-asserted-by":"publisher","unstructured":"Goyal P, Paul T, Almarzooq ZI, Peterson JC, Krishnan U, Swaminathan RV, et al. Sex- and Race-Related Differences in Characteristics and Outcomes of Hospitalizations for Heart Failure With Preserved Ejection Fraction. J Am Heart Assoc. 2017. https:\/\/doi.org\/10.1161\/JAHA.116.003330.","DOI":"10.1161\/JAHA.116.003330"},{"key":"944_CR44","unstructured":"P\u00f6lzl G, Pacher R, Altenberger J, Dornaus C, Ebner C, Ehmsen U, et al. Herzinsuffizienz-Register- (HIR-) Austria 2006-2009: Erfahrungen und Konsequenzen. J Kardiol. 2010:85\u201392."},{"key":"944_CR45","doi-asserted-by":"publisher","first-page":"1574","DOI":"10.1002\/ejhf.813","volume":"19","author":"O Chioncel","year":"2017","unstructured":"Chioncel O, Lainscak M, Seferovic PM, Anker SD, Crespo-Leiro MG, Harjola V-P, et al. Epidemiology and one-year outcomes in patients with chronic heart failure and preserved, mid-range and reduced ejection fraction: an analysis of the ESC heart failure long-term registry. Eur J Heart Fail. 2017;19:1574\u201385.","journal-title":"Eur J Heart Fail"},{"key":"944_CR46","doi-asserted-by":"publisher","first-page":"373","DOI":"10.1016\/0021-9681(87)90171-8","volume":"40","author":"ME Charlson","year":"1987","unstructured":"Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373\u201383.","journal-title":"J Chronic Dis"},{"key":"944_CR47","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1097\/00005650-199801000-00004","volume":"36","author":"A Elixhauser","year":"1998","unstructured":"Elixhauser A, Steiner C, Harris DR, Coffey RM. Comorbidity measures for use with administrative data. Med Care. 1998;36:8\u201327.","journal-title":"Med Care"},{"key":"944_CR48","doi-asserted-by":"publisher","first-page":"1130","DOI":"10.1097\/01.mlr.0000182534.19832.83","volume":"43","author":"H Quan","year":"2005","unstructured":"Quan H, Sundararajan V, Halfon P, Fong A, Burnand B, Luthi J-C, et al. Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care. 2005;43:1130\u20139.","journal-title":"Med Care"}],"container-title":["BMC Medical Informatics and Decision Making"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s12911-019-0944-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1186\/s12911-019-0944-3\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s12911-019-0944-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,11,20]],"date-time":"2020-11-20T02:06:29Z","timestamp":1605837989000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcmedinformdecismak.biomedcentral.com\/articles\/10.1186\/s12911-019-0944-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,11,21]]},"references-count":48,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2019,12]]}},"alternative-id":["944"],"URL":"https:\/\/doi.org\/10.1186\/s12911-019-0944-3","relation":{},"ISSN":["1472-6947"],"issn-type":[{"type":"electronic","value":"1472-6947"}],"subject":[],"published":{"date-parts":[[2019,11,21]]},"assertion":[{"value":"21 March 2019","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 October 2019","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 November 2019","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Clinical data was anonymized and provided by KAGes for purely scientific purposes, backtracking of individual patients is not possible. General outpatient data was anonymized and provided by the regional health insurance provider. Only secondary, prospective and anonymized data was used, hence ethical approval was not applicable. This complies with the Austrian Federal Act concerning the Protection of Personal Data (DSG) 2000 as lastly amended on the 25th of May 2018 by the Federal Law Gazette (BGBl.) Nr. 120\/2017, specifically $7(1) in \u2018part 2\u2019 on \u2018data processing for specific purposes\u2019.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"229"}}