Introduction

One of the main goals of OPIMEC is the creation of a taxonomy that can act as a common language to support the identification, selection, classification and implementation of innovative practices for the management of chronic diseases. The use of a common language will establish the main characteristics of each practice, facilitating comparison with other experiences.

This collaborative taxonomy, global and alive is related to the chapter 'The Language of Polypathology' of the book "When people live with multiple chronic diseases: a collaborative approach to the emerging global challenge" and is inspired in large part on the version of Krumholz taxonomy.

The following are terms related to complex chronic diseases, slide in a tree other related terms.

1. Chronic Diseases

MeSH:Chronic Diseases (http://www.ncbi.nlm.nih.gov/sites/entrez...)

Entry terms: Chronic Diseases; Disease, Chronic Diseases; Chronic; Chronic Illness; Chronic Illnesses; Illness, Chronic; Illnesses, Chronic; Chronically Ill

Chronic diseases are diseases of long duration and generally slow progression. Chronic diseases are the principal cause of death and disability in the world. The most common are cardiovascular diseases, cancer, chronic obstructive pulmonary disease and diabetes. Out of the 35 million people who died from chronic disease in 2005, half were under70 and half were women [1].  

It is expected that by 2020 they will be responsible for 73% of deaths worldwide and 60% of the world’s disease burden (Report of the World Health Organization 2002: “reducing risks and promoting and healthy life style” [2].  

Almost 80% of these deaths will happen in developing countries and will be related to life styles or biological factors potentially modifiable (e.g., high blood pressure or cholesterol levels, and obesity).

Chronic diseases are almost always incurable. Therefore, they cannot be treated. They can be managed.

According to the Chronic Disease Management initiative in British Columbia, Canada [3] . "Chronic disease management (CDM) is a systematic approach to improving health care for people with chronic disease. Health care can be delivered more effectively and efficiently if patients with chronic diseases take an active role in their own care and providers are supported with the necessary resources and expertise to better assist their patients in managing their illness.

CDM is an approach to health care that emphasizes helping individuals maintain independence and keep as healthy as possible through prevention, early detection, and management of chronic conditions, such as congestive heart failure, asthma, diabetes, and other debilitating illnesses.Chronic conditions impose challenges for those affected, their families and care providers. A patient's ability to follow medical advice, accommodate lifestyle changes, and access resources are all factors that influence successful management of an ongoing illness."

 MeSH: Disease Management http://www.ncbi.nlm.nih.gov/sites/entrez?Db=mesh&Cmd=ShowDetailView&TermToSearch=68019468&ordinalpos=1&itool=EntrezSystem2.PEntrez.Mesh.Mesh_ResultsPanel.Mesh_RVDocSu including also the previous category Patient Care Management http://www.ncbi.nlm.nih.gov/sites/entrez

1.1.1. Cerebro-vascular Disease/Stroke

MeSH: Cerebrovascular Disorders (http://www.ncbi.nlm.nih.gov/sites/entrez)

A spectrum of pathological conditions of impaired blood flow in the brain. They can involve vessels (ARTERIES; or VEINS) in the CEREBRUM, the CEREBELLUM, and the BRAIN STEM. Major categories include INTRACRANIAL ARTERIOVENOUS MALFORMATIONS; BRAIN ISCHEMIA; CEREBRAL HEMORRHAGE; and others

MeSH: Stroke (http://www.ncbi.nlm.nih.gov/sites/entrez?Db=mesh&Cmd=ShowDetailView&TermToSearch=68020521&ordinalpos=1&itool=EntrezSystem2.PEntrez.Mesh.Mesh_ResultsPanel.Mesh_RVDocSum)

A group of pathological conditions characterized by sudden, non-convulsive loss of neurological function due to BRAIN ISCHEMIA or INTRACRANIAL HEMORRHAGES. Stroke is classified by the type of tissue NECROSIS, such as the anatomic location, vasculature involved, etiology, age of the affected individual, and hemorrhagic vs. non-hemorrhagic nature. (From Adams et al., Principles of Neurology, 6th ed, pp777-810) Year introduced: 2008 (2000)

1.1.2. Coronary Heart Disease and Cardiac Failure

MeSH:Coronary Heart Disease (http://www.ncbi.nlm.nih.gov/sites/entrez...)

Pathological processes of CORONARY ARTERIES that may derive from a congenital abnormality, atherosclerotic, or non-atherosclerotic cause. Year introduced: 2008 (1987)

MeSH:Chronic Cardiac Failure (http://www.ncbi.nlm.nih.gov/sites/entrez?Db=mesh&Cmd=ShowDetailView&TermToSearch=68006333&ordinalpos=1&itool=EntrezSystem2.PEntrez.Mesh.Mesh_ResultsPanel.Mesh_RVDocSum)

A heterogeneous condition in which the heart is unable to pump out sufficient blood to meet the metabolic need of the body. Heart failure can be caused by structural defects, functional abnormalities (VENTRICULAR DYSFUNCTION), or a sudden overload beyond its capacity. Chronic heart failure is more common than acute heart failure which results from sudden insult to cardiac function, such as MYOCARDIAL INFARCTION A. Year introduced: 2008 (1966) 

1.1.3. Chronic Obstructive Pulmunary Disease (COPD) and Asthma

MeSH:Chronic Obstructive Pulmonary Disease (http://www.ncbi.nlm.nih.gov/sites/entrez 

 A disease of chronic diffuse irreversible airflow obstruction. Subcategories of COPD include CHRONIC BRONCHITIS and PULMONARY EMPHYSEMA

MeSH:Asthma (http://www.ncbi.nlm.nih.gov/sites/entrez?Db=mesh&Cmd=ShowDetailView&TermToSearch=68001249&ordinalpos=1&itool=EntrezSystem2.PEntrez.Mesh.Mesh_ResultsPanel.Mesh_RVDocSum)

A form of bronchial disorder associated with airway obstruction, marked by recurrent attacks of paroxysmal dyspnea, with wheezing due to spasmodic contraction of the bronchi. 

1.1.4. Dementia

MeSH:Dementia (http://www.ncbi.nlm.nih.gov/sites/entrezDb=mesh&Cmd=ShowDetailView&TermToSearch=68003704&ordinalpos=1&itool=EntrezSystem2.PEntrez.Mesh.Mesh_ResultsPanel.Mesh_RVDocSum 

An acquired organic mental disorder with loss of intellectual abilities of sufficient severity to interfere with social or occupational functioning. The dysfunction is multifaceted and involves memory, behaviour, personality, judgment, attention, spatial relations, language, abstract thought, and other executive functions. The intellectual decline is usually progressive, and initially spares the level of consciousness. Year introduced: 1981(1963)

1.1.5. Diabetes Mellitus

MeSH:Diabetes Mellitus http://www.ncbi.nlm.nih.gov/sites/entrez?Db=mesh&Cmd=ShowDetailView&TermToSearch=68003920&ordinalpos=1&itool=EntrezSystem2.PEntrez.Mesh.Mesh_ResultsPanel.Mesh_RVDocSum 

A heterogeneous group of disorders characterized by HYPERGLYCEMIA and GLUCOSE INTOLERANCE.

1.1.6. HIV/AIDS

MeSH:AIDS (http://www.ncbi.nlm.nih.gov/sites/entrez?Db=mesh&Cmd=ShowDetailView&TermToSearch=68000163&ordinalpos=1&itool=EntrezSystem2.PEntrez.Mesh.Mesh_ResultsPanel.Mesh_RVDocSum 

Acquired Immunodeficiency Syndrome. An acquired defect of cellular immunity associated with infection by the human immunodeficiency virus (HIV), a CD4-positive T-lymphocyte count under 200 cells/microliter or less than14% of total lymphocytes, and increased susceptibility to opportunistic infections and malignant neoplasms. Clinical manifestations also include emaciation (wasting) and dementia. These elements reflect criteria for AIDS as definedby the CDC in 1993. Year introduced: 1983.

MeSH:HIV Infections (http://www.ncbi.nlm.nih.gov/sites/entrez?Db=mesh&Cmd=ShowDetailView&TermToSearch=68006678&ordinalpos=3&itool=EntrezSystem2.PEntrez.Mesh.Mesh_ResultsPanel.Mesh_RVDocSum 

Includes the spectrum of human immunodeficiency virus infections that range from asymptomatic seropositivity, thru AIDS-related complex ( ARC), to acquired immunodeficiency syndrome ( AIDS). Year introduced: 1990

MeSH:HIV http://www.ncbi.nlm.nih.gov/sites/entrez?Db=mesh&Cmd=ShowDetailView&TermToSearch=68006678&ordinalpos=3&itool=EntrezSystem2.PEntrez.Mesh.Mesh_ResultsPanel.Mesh_RVDocSum

Human immunodeficiency virus. A non-taxonomic and historical term referring to any of two species, specifically HIV-1 and/or HIV-2. Prior to 1986, this was called human T-lymphotropic virus type III/lymphadenopathy-associated virus (HTLV-III/LAV). From 1986-1990, it was an official species called HIV. Since 1991, HIV was no longer considered an official species name; the two species were designated HIV-1 and HIV-2. Year introduced: 1988

1.1.7. Musculoskeletal Diseases/Rheumatic and Osteoarticular Disorders

MeSH:Rheumatic Disease http://www.ncbi.nlm.nih.gov/sites/entrez?Db=mesh&Cmd=ShowDetailView&TermToSearch=68012216&ordinalpos=1&itool=EntrezSystem2.PEntrez.Mesh.Mesh_ResultsPanel.Mesh_RVDocSum 

Disorders of connective tissue, especially the joints and related structures, characterized by inflammation,degeneration, or metabolic derangement. Year introduced: 1990

MeSH:Osteoarthritis (http://www.ncbi.nlm.nih.gov/sites/entrez?Db=mesh&Cmd=ShowDetailView&TermToSearch=68010003&ordinalpos=1&itool=EntrezSystem2.PEntrez.Mesh.Mesh_ResultsPanel.Mesh_RVDocSum 

A progressive, degenerative joint disease, the most common form of arthritis, especially in older persons. The disease is thought to result not from the aging process but from biochemical changes and biomechanical stresses affecting articular cartilage. In the foreign literature it is often called osteoarthrosis deformans.

MeSH:Musculoskeletal Disease

(http://www.ncbi.nlm.nih.gov/sites/entrez?Db=mesh&Cmd=ShowDetailView&TermToSearch=68009140&ordinalpos=7&itool=EntrezSystem2.PEntrez.Mesh.Mesh_ResultsPanel.Mesh_RVDocSumRVDocSum 

Diseases of the muscles and their associated ligaments and other connective tissue and of the bones and cartilage viewed collectively. Year introduced: 1992

MeSH: Osteoporosis (http://www.ncbi.nlm.nih.gov/mesh/68010024).

Reduction of bone mass without alteration in the composition of bone, leading to fractures. Primary osteoporosis can be of two major types: postmenopausal osteoporosis (OSTEOPOROSIS, POSTMENOPAUSAL) and age-related or senile osteoporosis.

1.1.8. Oncology/Cancer

MeSH: Oncology  http://www.ncbi.nlm.nih.gov/sites/entrez?Db=mesh&Cmd=ShowDetailView&TermToSearch=68008495&ordinalpos=3&itool=EntrezSystem2.PEntrez.Mesh.Mesh_ResultsPanel.Mesh_RVDocSum 

A subspecialty of internal medicine concerned with the study of neoplasms.

MeSH: Neoplasms  http://www.ncbi.nlm.nih.gov/sites/entrez?Db=mesh&Cmd=ShowDetailView&TermToSearch=68008495&ordinalpos=3&itool=EntrezSystem2.PEntrez.Mesh.Mesh_ResultsPanel.Mesh_RVDocSum 

New abnormal growth of tissue. Malignant neoplasms show a greater degree of anaplasia and have the properties of invasion and metastasis, compared to benign neoplasms.

1.1.9. Psychiatric Disease

MeSH:Psychiatric Diseasehttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=mesh&Cmd=ShowDetailView&TermToSearch=68001523&ordinalpos=1&itool=EntrezSystem2.PEntrez.Mesh.Mesh_ResultsPanel.Mesh_RVDocSum

Mental Disorder or Psychiatric illness manifested by breakdowns in the adaptational process expressed primarily as abnormalities of thought, feeling, and behavior producing either distress or impairment of function. Year introduced: use pre-explosion 1974-1997

1.1.10. Renal Disease

MeSH:Chronic Kidney Failure,  

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=mesh&Cmd=ShowDetailView&TermToSearch=68007676&ordinalpos=1&itool=EntrezSystem2.PEntrez.Mesh.Mesh_ResultsPanel.Mesh_RVDocSum

The end-stage of CHRONIC RENAL INSUFFICIENCY. It is characterized by the severe irreversible kidney damage (as measured by the level of PROTEINURIA) and the reduction in GLOMERULAR FILTRATION RATE to less than 15 ml per min (Kidney Foundation: Kidney Disease Outcome Quality Initiative, 2002). These patients generally require HEMODIALYSIS or KIDNEY TRANSPLANTATION

1.1.11. Other Frequent Diseases

This category is reserved to diseases that have not been listed up to this point, but that have medium to high Prevalence in the population.

1.1.12. Rare Diseases

MeSH: Rare Diseases http://www.ncbi.nlm.nih.gov/sites/entrez

A large group of diseases which are characterized by a low prevalence in the population. They frequently are associated with problems in diagnosis and treatment.

1.2.Complex, Chronic Diseases (Polypathology)

A situation in which an individual is living with multiple (usually 3 or more), simultaneous, chronic and largely incurable conditions.

1.2.1. Co-morbidity

MeSH: Comorbidity http://www.nlm.nih.gov/cgi/mesh/2008/MB_cgi?mode=&term=Comorbidity&field=entry

The presence of co-existing or additional diseases with reference to an initial diagnosis or with reference to the index condition that is the subject of study. Comorbidity may affect the ability of affected individuals to function and also their survival; it may be used as a prognostic indicator for length of hospital stay, cost factors, and outcome or survival. As an example, an individual could live with multiple chronic conditions such as paralysis, incontinence, dementia and pain, all stemming from a single disease like multiple sclerosis.

Comordibity could be classified in three groups depending on the relation between the index disease and the accompanying conditions:

1. Random. These are the comorbidities that occur together with a frequency no different than the individual prevalences multiplied together, that is to say the associations occur by chance. An example in our practice is the co-existence of hand warts and osteoarthritis.
2. Consequential (classified in the literature as casual or complicated co-morbidity). These are conditions that are pathophysiologically part of the same process. it is no surprise to find that diabetes and hypertension occur together more than by chance, so these co morbidities, though interesting, are predictable.
3. Cluster co-morbidity is the non random clustering of health conditions without an evident underlying pathophysiological cause. Here is the opportunity for new discoveries - either new understandings of pathophysiology, or a new appreciation of the nature of complexity.

1.2.2. Coexisting/concurrent Diseases

The presence of multiple chronic diseases in a patient with no reference to an initial diagnosis or relationship to a common disease. As an example, an individual could live with multiple diseases such as diabetes, osteoarthritis and early dementia.

1.2.3. Confluent morbidity

Confluent morbidity occurs when the number of chronic conditions and medications taken to control the chronic

condition prevent simple single causal identification of common symptoms such as weakness, fatigue, dizziness. In short, confluent morbidity occurs when disease manifestations and medication effects are inseparable [4].

2. Patient Population

MeSH:Patients http://www.ncbi.nlm.nih.gov/sites/entrez?Db=mesh&Cmd=ShowDetailView&TermToSearch=68010361&ordinalpos=1&itool=EntrezSystem2.PEntrez.Mesh.Mesh_ResultsPanel.Mesh_RVDocSum

 Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures.

2.1. Population Characteristics

MeSH:Population Characteristics http://www.ncbi.nlm.nih.gov/sites/entrez

Qualities and characterization of various types of populations within a social or geographic group, with emphasis on demography, health status, and socioeconomic factors. Year introduced: 1998

2.2. Signs and Symptoms

MeSH:Signs and Symptoms http://www.ncbi.nlm.nih.gov/sites/entrez?Db=mesh&Cmd=ShowDetailView&TermToSearch=68012816&ordinalpos=4&itool=EntrezSystem2.PEntrez.Mesh.Mesh_ResultsPanel.Mesh_RVDocSum

Clinical manifestations that can be either objective when observed by a physician, or subjective when perceived by the patient. Year introduced: 1998

2.3. Risk Status

MeSH:Risk  

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=mesh&Cmd=ShowDetailView&TermToSearch=68012306&ordinalpos=1&itool=EntrezSystem2.PEntrez.Mesh.Mesh_ResultsPanel.Mesh_RVDocSum

The probability that an event will occur. It encompasses a variety of measures of the probability of a generally unfavourable outcome. High-risk groups—such as older patients, patients with a history of prior hospitalizations, and patients with significant co morbidities—may experience fewer hospitalizations in re-sponse to disease management. Failure to account for the risk status of the target population can therefore lead to inappropriate comparisons between interventions.

Risk Status with respect to progression and complications related to a particular health condition must be distinguished from risk factors for the conditions, though there may be overlap. For example, obesity may constitute an element affecting risk status as well as a risk factor as relates to diabetes. Positive family history would be a risk factor but not influence risk status.

2.4. Disability

MeSH:Disabled Persons  

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=mesh&Cmd=ShowDetailView&TermToSearch=68006233&ordinalpos=1&itool=EntrezSystem2.PEntrez.Mesh.Mesh_ResultsPanel.Mesh_RVDocSum

Persons with physical or mental disabilities that affect or limit their activities of daily living and that may require special accommodations. 

2.5. Dependency

MeSH:Dependency http://www.ncbi.nlm.nih.gov/sites/entrez

The tendency of an individual or individuals to rely on others for advice, guidance, or support. Year introduced: 1991(1975) – For people living with chronic diseases, dependency tends to be a permanent, irreversible situation, thereby they need others to complete basic activities of daily living, as they have lost their physical, mental or social autonomy.

2.6. Non clinical Characteristics

There are several aspects of people's lives that can have a profound influence on their health status and the way in which they cope with chronic conditions. These include gender, educational level, marital status, involvement in religious activities, socio-economic status, degree of perceived control over day-to-day decisions.

2.7. Events

The encounters of a person living with chronic diseases as recorded in health service databases. "High event" patients are those who have experienced three or more acute care hospitalizations as a result of their chronic illness. Those with complex, chronic conditions who have repeated hospital admissions or visits to the emergency department are also known as "frequent flyers" [5].

2.8.Registries

MeSH:Registries  

http://www.ncbi.nlm.nih.gov/sites/entrez

Entry Terms: Registry, Parish Registers, Parish Register, Register, Paris,Population Register, Population Registers,Register Population

The systems and processes involved in the establishment, support, management, and operation of registers, e.g., disease registers. Year introduced: 1972(1969) - Updated lists of patients with a particular condition are also an important element of proactive chronic disease management. These registries may be developed at a practice or program level though the evolution to population based management strategies has increased the discussion of geographic or jurisdictional registries. Suchregistries require strong policy and, in some instances, legislative frameworks. 

3. Recipient

Usually, the person who is targeted by the intervention is the same that is expected to benefit from it. For instance, a medication prescribed to a patient with high blood pressure is meant to benefit such patient. However, in other situations the intervention could target a caregiver or even a health professional, who indirectly would benefit the patient. 

3.1.Patient

MeSH:Patient http://www.ncbi.nlm.nih.gov/sites/entrez 

Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures.

3.2. Caregiver

Mesh:Caregiver http://www.ncbi.nlm.nih.gov/sites/entrez?Db=mesh&Cmd=ShowDetailView&TermToSearch=68017028&ordinalpos=1&itool=EntrezSystem2.PEntrez.Mesh.Mesh_ResultsPanel.Mesh_RVDocSum

Persons who provide care to those who need supervision or assistance in illness or disability. They may provide the care in the home, in a hospital, or in an institution. Although caregivers include trained medical, nursing, and other health personnel, the concept also refers to parents, spouses, or other family members, friends, members of the clergy, teachers, social workers, fellow patients, etc. (see below) Year introduced: 1992

3.3. Physicians and other healthcare professionals

 MeSH: Physicians (http://www.ncbi.nlm.nih.gov/mesh/68010820?ordinalpos=1&itool=EntrezSystem2.PEntrez.Mesh.Mesh_ResultsPanel.Mesh_RVDocSum)

Frequently, the intervencion receptors are not patients, but healthcare professionals. It happens with educative or formative interventions related to chronic disease.

Invididuals licensed to practice medicine.

4. Intervention Content

MeSH:Therapy http://www.ncbi.nlm.nih.gov/sites/entrez?Db=mesh&Cmd=ShowDetailView&TermToSearch=81000628&ordinalpos=2&itool=EntrezSystem2.PEntrez.Mesh.Mesh_ResultsPanel.Mesh_RVDocSum

Used with diseases for therapeutic interventions except drug therapy, diet therapy, radiotherapy, and surgery, for which specific subheadings exist. The concept is also used for articles and books dealing with multiple therapies. Disease management interventions range widely from a single educational session to remote electronic monitoring to comprehensive programs involving multidisciplinary care teams. This variety reflects the perspective of those providing the intervention (e.g., physician, nurse, or pharmacist), issues specific to the patient population, and the goals of the funding organization)

4.1. Drug Therapy

MeSH:Drug Therapy  

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=mesh&Cmd=ShowDetailView&TermToSearch=81000188&ordinalpos=2&itool=EntrezSystem2.PEntrez.Mesh.Mesh_ResultsPanel.Mesh_RVFull

Used with disease headings for the treatment of disease by the administration of drugs, chemicals, and antibiotics. For diet therapy and radiotherapy, use specific subheadings. Excludes immunotherapy for which "therapy" is used. Year introduced: 1966 

4.2. Surgical Procedures

MeSH:Surgical Procedures http://www.ncbi.nlm.nih.gov/sites/entrez?Db=mesh&Cmd=ShowDetailView&TermToSearch=68013514&ordinalpos=3&itool=EntrezSystem2.PEntrez.Mesh.Mesh_ResultsPanel.Mesh_RVDocSum

Operations carried out for the correction of deformities and defects, repair of injuries, and diagnosis and cure of certain diseases. Year introduced: 1998(1963) 

4.3. Complementary Therapies

MeSH:Complementary Therapies http://www.ncbi.nlm.nih.gov/sites/entrez?Db=mesh&Cmd=ShowDetailView&TermToSearch=68000529&ordinalpos=1&itool=EntrezSystem2.PEntrez.Mesh.Mesh_ResultsPanel.Mesh_RVDocSum

Therapeutic practices which are not currently considered an integral part of conventional allopathic medical practice.

They may lack biomedical explanations but as they become better researched some (PHYSICAL THERAPY MODALITIES; DIET; ACUPUNCTURE) become widely accepted whereas others (humors, radium therapy) quietly fade away, yet are important historical footnotes. Therapies are termed as Complementary when used in addition to conventional treatments and as Alternative when used instead of conventional treatment. Year introduced: 2002(1986) 

4.4. Other Conventional Therapies

Procedures concerned with the remedial treatment or prevention of diseases that do not involve drugs, surgery or complementary therapies (e.g., radiation, massage, nutritional interventions)

4.5.1. Palliative Care (Sympton Control)

MeSH: Palliative Care  

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=mesh&Cmd=ShowDetailView&TermToSearch=68010166&ordinalpos=14&itool=EntrezSystem2.PEntrez.Mesh.Mesh_ResultsPanel.Mesh_RVFull

 Care alleviating symptoms without curing the underlying disease. (Stedman, 25th ed) Year introduced: 1996 

4.5.2. Emotional and Psychological Support

Care aimed at relieving distress, anxiety, fear or any other non-physical source of suffering.

4.5.3. Informational Support

These are efforts designed to meet the needs of patients and loved ones for information about any aspect of a chronic condition.

4.5.4. Social Support

MeSH: Social Support  

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=mesh&Cmd=ShowDetailView&TermToSearch=68012944&ordinalpos=2&itool=EntrezSystem2.PEntrez.Mesh.Mesh_ResultsPanel.Mesh_RVFull

Support systems that provide assistance and encouragement to individuals with physical or emotional disabilities in order that they may better cope. Informal social support is usually provided by friends, relatives, or peers, while

formal assistance is provided by churches, groups, etc. Year introduced: 1991(1983)

4.5.5. Financial Support

MeSH: Financial Support  

http://www.ncbi.nlm.nih.gov/sites/entrez

The provision of monetary resources including money or capital and credit; obtaining or furnishing money or capital for a purchase or enterprise and the funds so obtained. (From Random House Unabridged Dictionary, 2d ed.) Year introduced: 1996

4.6. Educational Intervention

An influencing force or act that occurs in order to modify a given state of affairs through the acquisition of knowledge.

4.7. Remote Monitoring

MeSH:Monitoring, Ambulatory http://www.ncbi.nlm.nih.gov/sites/entrez

The use of electronic equipment to observe or record physiologic processes while the patient undergoes normal daily activities. Refers to the measurement of physiological processes such as vital signs (heart rate, respiration, blood pressure, temperature) and other measurements (blood cells, blood chemistry, renal output, etc) at a distance using digital and analog technology.

4.8. Concordance

This term refers to an interaction between a health care provider and a person living with chronic conditions (and or their family/support person (s) whereby the implementation or use of an intervention is negotiated from the perspective of both best health evidence and outcomes, and preferences. Older related terms include compliance, adherence and joint decision-making.

4.9. Medication Therapy Management

MesH :Medication Therapy Management (http://www.ncbi.nlm.nih.gov/mesh/68054539?ordinalpos=1&itool=EntrezSystem2.PEntrez.Mesh.Mesh_ResultsPanel.Mesh_RVDocSum)

Assistance in managing and monitoring drug therapy for patients receiving treatment for cancer or chronic conditions such as asthma and diabetes, consulting with patients and their families on the proper use of medication; conducting wellness and disease prevention programs to improve public health; overseeing medication use in a variety of settings.

5.1. Nurses

MeSH:Nurses  

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=mesh&Cmd=ShowDetailView&TermToSearch=68009726&ordinalpos=1&itool=EntrezSystem2.PEntrez.Mesh.Mesh_ResultsPanel.Mesh_RVDocSum

Professionals qualified by education at an accredited school of nursing and licensed by state law to practice nursing.

They provide services to patients requiring assistance in recovering or maintaining their physical or mental health.Year introduced: 1967(1965) 

5.2. Physicians

MeSH: Physicians (http://www.ncbi.nlm.nih.gov/sites/entrez...)

Individuals licensed to practice medicine.

5.3. Pharmacists

MeSH Pharmacists: http://www.ncbi.nlm.nih.gov/sites/entrez?Db=mesh&Cmd=ShowDetailView&TermToSearch=68010595&ordinalpos=1&itool=EntrezSystem2.PEntrez.Mesh.Mesh_ResultsPanel.Mesh_RVDocSum

Those persons legally qualified by education and training to engage in the practice of pharmacy. Year introduced: 1968

5.4. Social Workers

MeSH Social Workers:http://www.ncbi.nlm.nih.gov/sites/entrez?Db=mesh&Cmd=ShowDetailView&TermToSearch=68012947&ordinalpos=1&itool=EntrezSystem2.PEntrez.Mesh.Mesh_ResultsPanel.Mesh_RVDocSum

The use of community resources, individual case work, or group work to promote the adaptive capacities of individuals in relation to their social and economic environments. It includes social service agencies. Year introduced:1978

5.5.Registered Dietitians

Registered dietitians are uniquely trained to give advice on food, diet and nutrition. Registration within a regulatory body assures the public and employers that an individual has met the standards for academic and practical experience required for the practice of the profession of dietetics.

5.6. Occupational Therapists

MeSH: Occupational therapy:http://www.ncbi.nlm.nih.gov/sites/entrez?Db=mesh&Cmd=ShowDetailView&TermToSearch=68009788&ordinalpos=6&itool=EntrezSystem2.PEntrez.Mesh.Mesh_ResultsPanel.Mesh_RVDocSum 

Personnel who work in occupational therapy, the field concerned with utilizing craft or work activities in the rehabilitation of patients. Occupational therapy can also refer to the activities themselves.

 Professionals who evaluate the self-care, work and leisure skills of a person and plans and implements social and interpersonal activities to develop, restore, and/or maintain the person's ability to accomplish activities of daily living (eating, dressing, bathing) and necessary occupational tasks [6].

5.7. Radiation Therapists

MeSH Radiotherapy: http://www.ncbi.nlm.nih.gov/sites/entrez...

 Individual involved in the therapeutic use of ionizing and nonionizing radiation. It includes the use of radioisotope therapy. Year introduced: 1966

5.8. Physical Therapists (Physiotherapists)

MeSH Physical Therapy: http://www.ncbi.nlm.nih.gov/sites/entrez?Db=mesh&Cmd=ShowDetailView&TermToSearch=68026761&ordinalpos=3&itool=EntrezSystem2.PEntrez.Mesh.Mesh_ResultsPanel.Mesh_RVDocSum

The auxiliary health profession which makes use of physical therapy modalities to prevent, correct, and alleviate movement dysfunction of anatomic or physiologic origin. Year introduced: 2002

5.9. Psychologists

MeSH Psychological Techniques:  http://www.ncbi.nlm.nih.gov/sites/entrez?Db=mesh&Cmd=ShowDetailView&TermToSearch=68011580&ordinalpos=1&itool=EntrezSystem2.PEntrez.Mesh.Mesh_ResultsPanel.Mesh_RVDocSum

Individuals involved in the diagnosis and treatment of behavioral, personality, and mental disorders. Year introduced: 1998

5.10. Case Managers/Care Coordinators

MeSH Case management: http://www.ncbi.nlm.nih.gov/sites/entrez?Db=mesh&Cmd=ShowDetailView&TermToSearch=68019090&ordinalpos=2&itool=EntrezSystem2.PEntrez.Mesh.Mesh_ResultsPanel.Mesh_RVFull

A traditional term for all the activities which a physician or other health care professional normally performs to insure the coordination of the medical services required by a patient. It also, when used in connection with managed care, covers all the activities of evaluating the patient, planning treatment, referral, and follow-up so that care is continuous and comprehensive and payment for the care is obtained. (From Slee & Slee, Health Care Terms, 2nd ed)Year introduced: 1996 .

 Individuals responsible for generating, planning, organizing, and monitoring the provision of services for patients.

5.11.Ethicists

MeSH: Ethicists (http://www.ncbi.nlm.nih.gov/sites/entrez...)

Persons trained in philosophical or theological ethics who work in clinical, research, public policy, or other settings where they bring their expertise to bear on the analysis of ethical dilemmas in policies or cases. Year introduced: 2002

5.12. Massage Therapists

MeSH: Massage (http://www.ncbi.nlm.nih.gov/sites/entrez...)

Professionals who perform manipulations of body tissues for the purpose of affecting the nervous and muscular systems and the general circulation.

5.13. Others involved in health Service Delivery

Individuals who do not belong to any of the above categories.

5.14. Shared Competencies

The overlap in the scope of practice of health care professionals in areas of common ability for service provision.

5.15. Peer Support

The informal assistance and encouragement provided to individuals with physical or emotional disabilities by peers

with similar ailments or interests. It may be an adjunct to self-management.

5.16. Self-management

MeSH: Self Care http://www.ncbi.nlm.nih.gov/sites/entrez?Db=mesh&Cmd=ShowDetailView&TermToSearch=68012648&ordinalpos=1&itool=EntrezSystem2.PEntrez.Mesh.Mesh_ResultsPanel.Mesh_RVDocSum

The care of oneself or one's family and friends and encompasses activities or tasks traditionally performed by professional health care providers.

6.1. Direct (In person)

The exchange or transmission of ideas, attitudes, or beliefs among individuals or groups who are in each other's presence.

6.2. Virtual/Remote (Telehealth/Telemedicine)

MeSH:Remote Consultation http://www.ncbi.nlm.nih.gov/sites/entrez

Delivery of health services via remote telecommunications. This includes interactive consultative and diagnostic services. Year introduced: 1993

This category also includes telemonitoring, an approach that combines various information technologies for capturing, transmitting and analyzing physiological variables from patients with chronic conditions across long distances; and virtual communities (e.g., wikis, mailing lists, bulletin boards and other online social networks).

6.2.1.Real time or Synchronous

Real-time telehealth involves the use of information and communication technologies (e.g., a minimum set of video cameras, computer displays, and a secure high-speed Internet connection) to enable individuals to communicate live (or synchronously) over long and short distances [7]. Much simpler technologies could also be used for real-time support. For instance, the telephone can be a powerful tool to optimize

the assessment, planning, provision of information as well as support, evaluation, and documentation across long distances. (Government of the Northwest Territories Department of Health Policies and Guidelines for Community Health Nurses, Canada, 2008)

6.2.2. Store and forward or Asynchronous

Asynchronous telehealth refers to the storage of clinically important digital samples and relevant data from any location and forwarding them to a health care professional at a distant site for assessment at a convenient time [8]. It is also known as store-and-forward telehealth. With the widespread

penetration of the Internet, the reduction in cost of data storage and the proliferation of digital cameras, patients who own Web cameras could request routine consultations with health professionals from home. Telephones with cameras are making multimedia teleconsultations possible from anywhere [9].

7.1. Intensity

The resulting interactions of the duration, frequency and periodicity of chronic disease management interventions.

7.2. Complexity

The number of diversity of the components of chronic disease management interventions, the extent to which they relate to each other. The term also includes the degree of information exchange among patients, caregivers and health professionals (Information Complexity) [4] , the time consumed by the interventions (Time Management Complexity) [4], and the extent to which nuanced discussions and deliberations are required to handle the uncertainty associated with the probability of outcomes relating to diagnostic or therapeutic interventions (Interpretive Complexity) [4].

8. Environment

The setting in which disease management interventions are delivered also has the potential to affect both patient and financial outcomes.

8.1. Institucional/Health Facilities

MeSH:Health Facilities (http://www.ncbi.nlm.nih.gov/sites/entrez?Db=mesh&Cmd=ShowDetailView&TermToSearch=68006268&ordinalpos=1&itool=EntrezSystem2.PEntrez.Mesh.Mesh_ResultsPanel.Mesh_RVDocSum)

Institutions which provide medical or health-related services.

8.1.1. Primary Care Centres

MeSH Primary Health Care: (http://www.ncbi.nlm.nih.gov/sites/entrez...)

Settings where integrated, accessible health care services are provided by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community.

See also,  

MeSH: Community Health Centers: (http://www.ncbi.nlm.nih.gov/sites/entrez...)

Facilities that manage the provision of health care to people living in a community or neighborhood. Year of introduction: 1979.

8.1.2. Hospitals

MeSH Hospitals: (http://www.ncbi.nlm.nih.gov/sites/entrez... TermToSearch=68006761&ordinalpos=1 itool=EntrezSystem2.PEntrez.Mesh.Mesh_ResultsPanel.Mesh_RVDocSum)

Institutions with an organized medical staff which provide medical care to patients.

8.1.3. Long Term Care Facilities/Nursing Homes

MeSH Nursing Homes (http://www.ncbi.nlm.nih.gov/sites/entrez...)

Facilities which provide nursing supervision and limited medical care to persons who do not require hospitalization.

8.1.4. Hospices

MeSH:Hospices (http://www.ncbi.nlm.nih.gov/sites/entrez...)

Facilities or services which are especially devoted to providing palliative and supportive care to the patient with a terminal illness and to the patient's family.

8.2. Other institutions

Other formal settings which provide medical or health-related services not included in any of the above categories.

8.3.1. Homes

The place where patients live permanently. This includes retirement homes (also known as housing for the aged), or housing arrangements for the elderly or aged, intended to foster independent living. The housing may take the form of group homes or small apartments (see Housing for the Aged (http://www.ncbi.nlm.nih.gov/sites/entrez...)

8.3.2. Workplace

MeSH:Workplace (http://www.ncbi.nlm.nih.gov/sites/entrez...)

Place or physical location of work or employment.

8.3.3. Schools

MeSH:Schools (http://www.ncbi.nlm.nih.gov/sites/entrez...)

Educational institutions.

8.3.4. Other non-institutional

Settings not included under any of the above categories in this sub-section.

9.1. Clinical

MeSH:Outcome Assessment (Health Care) (http://www.ncbi.nlm.nih.gov/sites/entrez...)

The quality and effectiveness of health care as measured by the attainment of a specified end result or outcome.

Measures include parameters such as improved health, lowered morbidity or mortality, and improvement of abnormal states (such as elevated blood pressure).

9.2. Process

MeSH:Process Assessment (http://www.ncbi.nlm.nih.gov/sites/entrez...)

An evaluation procedure that focuses on how care is delivered, based on the premise that there are standards of performance for activities undertaken in delivering patient care, in which the specific actions taken, events occurring, and human interactions are compared with accepted standards.

9.3. Satisfaction

MeSH:Personal Satisfaction (http://www.ncbi.nlm.nih.gov/sites/entrez...)

The individual's experience of a sense of fulfillment of a need or want and the quality or state of being satisfied.

9.4. Resources utilization

Health Resources (http://www.ncbi.nlm.nih.gov/sites/entrez...)

Available manpower, facilities, revenue, equipment, and supplies to produce requisite health care and services.

9.5. Other Outcomes

Any other end result not included in the above list. 

10.1. Continuity of Care Health Promotion

MeSH: Continuity of Patient Care

(http://www.ncbi.nlm.nih.gov/sites...)

Medical care provided continuously from the initial contact, following the patient through all phases of medical care. Year of introduction: 1991 (1975).

10.1.1. Health Promotion

MeSH:Health Promotion (http://www.ncbi.nlm.nih.gov/sites/entrez?Db=mesh&Cmd=ShowDetailView&TermToSearch=68006293&ordinalpos=1&itool=EntrezSystem2.PEntrez.Mesh.Mesh_ResultsPanel.Mesh_RVFull)

Encouraging consumer behaviors most likely to optimize health potentials (physical and psychosocial) through health information, preventive programs, and access to medical care.

10.1.2. Early Diagnosis

MeSH:Early Diagnosis (http://www.ncbi.nlm.nih.gov/sites/entrez...)

Methods to determine in patients the nature of a disease or disorder at its early stage of progression. Generally, early diagnosis improves prognosis and treatment outcome.

10.1.3. Therapy

Intervention(s) intended to relieve or heal a disorder.

10.1.4. Rehabilitation

MeSH:Rehabilitation(http://www.ncbi.nlm.nih.gov/sites/entrez?Db=mesh&Cmd=ShowDetailView&TermToSearch=68012046&ordinalpos=1&itool=EntrezSystem2.PEntrez.Mesh.Mesh_ResultsPanel.Mesh_RVDocSum)

Restoration of human functions to the maximum degree possible in a person or persons suffering from disease or injury.

10.1.5. Terminal care

MeSH: Terminal Care (http://www.ncbi.nlm.nih.gov/sites/entrez...)

Medical and nursing care of patients in the terminal stage of an illness.

10.1.6. Bereavement

MeSH Bereavement (http://www.ncbi.nlm.nih.gov/sites/entrez...)

The whole process of grieving and mourning and is associated with a deep sense of loss and sadness.

10.2.1. Clinical Protocols

MeSH: Clinical Protocols (http://www.ncbi.nlm.nih.gov/sites/entrez...)

Precise and detailed plans for the study of a medical or biomedical problem and/or plans for a regimen of therapy.

10.2.2. Critical Pathways

MeSH:Critical Pathways ( http://www.ncbi.nlm.nih.gov/sites/entrez?Db=mesh&Cmd=ShowDetailView&TermToSearch=68019091&ordinalpos=5&itool=EntrezSystem2.PEntrez.Mesh.Mesh_ResultsPanel.Mesh_RVFull)

Schedules of medical and nursing procedures, including diagnostic tests, medications, and consultations designed to effect an efficient, coordinated program of treatment.

10.2.3. Practice Guidelines

MeSH: Practice Guidelines (Click here)

Directions or principles presenting current or future rules of policy for assisting health care practitioners in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery.

Contributors

The first version of this taxonomy was developed by Alex Jadad, Francisco Martos and Jessie Venegas, receiving contributions from Jackie Bender, Andrés Cabrera, Maria Teresa Gijón, Diana Gosálvez, Laura O'Grady, Jennifer Painter, Peter Sargious and Ross Upshur.

The responsibility for content lies with the major contributors and not necessarily represent the views of the Andalusian Ministry or any other organization participating in this effort.

Acknowledgements

It is inspired by multiple sources and in large part on the taxonomy version from Krumholz HM, Currie PM, Riegel B, Phillips CO, Peterson ED, Smith R, Yancy CW, Faxon DP. "A taxonomy for disease management: A scientific statement from the American Heart Association Disease Management Taxonomy Writing Group." Circulation 2006; 114: 1432-1445.[10]

How to cite

Jadad AR*, Martos F*, Venegas J*, Bender J, Cabrera A, Gijon MT, Gosalvez D, O'Grady L, Painter J, Sargious P and Upshur R. [*Main contributors]. Collaborative, global and live taxonomy about complex chronic disease. Availabel at: http://www.opimec.org/glosario

References

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3. British Columbia. Chronic Disease Management in B.C. [Web Site]. Vancouver: British Columbia; 2001. [Revision date, February 14th, 2007]. Available at: http://www.health.gov.bc.ca/cdm/cdminbc/index.html
4. Joint Centre for Bioethics. [Web Site]. Toronto: University of Toronto. [Access Date, September16th, 2010]. Available at: http://www.jointcentreforbioethics.ca/
5. Bonollo M. Managing People with Co-Morbidities; Outcomes of Disease  Management Unit. En: Plenary Singapore Conference 2008. Singapore; 2008. Available at: http://www.dmconf.com.sg/2008/slides/8_May/8_May_Ballroom2/P2%20Marco%20Bonollo.pdf
6. Jim&Adler Associates [Web Site]. Texas: Jim&Adler Associates. [Access date, September 16th, 2010]. Glossary of Legal Terms[1]. Available at: http://www.jimadler.com/glossary-of-legal-terms.html  
7. Deshpande A, Khoja S, McKibbon A, Jadad A R. Real-Time (Synchronous) Telehealth in Primary Care: Systematic Review of Systematic Reviews [Technology report no 100]. Ottawa: Canadian Agency for Drugs and Technologies in Health; 2008. Available at: http://www.cadth.ca/index.php/en/publication/788
8. Deshpande A, Khoja S, Lorca J, McKibbon A, Rizo C, Jadad A R. Asynchronous Telehealth: Systematic Review of Analytic Studies and Environmental Scan of Relevant Initiatives[Technology report no 101]. Ottawa: Canadian Agency for Drugs and Technologies in Health; 2008. Available at: http://www.cadth.ca/index.php/en/publication/789
9. Jadad A. A view from the Internet age: Let's build a health system that meets the needs of the next generation. CMAJ. 2004; 171(12). Available at: http://www.cmaj.ca/cgi/content/full/171/12/1457
10. Krumholz HM, Currie PM, Riegel B, Phillips CO, Peterson ED, Smith R, Yancy CW, Faxon DP. A taxonomy for disease management: A scientific statement from the American Heart Association Disease Management Taxonomy Writing Group. Circulation. 2006; 114: 1432-1445. Available at: http://circ.ahajournals.org/cgi/content/short/114/13/1432

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 Collaborative, global and live taxonomy about complex chronic disease . Jadad AR*, Martos F*, Venegas J*, Bender J, Cabrera A, Gijon MT, Gosalvez D, O'Grady L, Painter J, Sargious P and Upshur R [*Main contributors] is licensed under a Creative Commons Reconocimiento-No comercial-Sin obras derivadas 3.0 España License.