Clinical Factors

These are the Clinical Factors that are a component of the Patient Recovery Factors.

Clinical Conditions

Clinical Conditions are elements of the clinical factors in patient recovery. Medicare has developed a model to categorize the clinical conditions factors in order to risk risk adjust health insurers that are covering patients. The CMS-HCC Risk Adjustments model adjust for patient demographics (i.e., age, disabled) and disease (i.e., diabetes, congested heart failure).

Behavioral Health

• Addictions
• Behavioral Disorders (depression, anxiety disorders, schizophrenia, bipolar etc.)
• Substance Abuse

Comorbidities

Comorbidities are chronic disorders (or diseases) that need to be managed. Most comorbidities do not get cured. Comorbidities include behavioral or mental disorders.

• Alzheimer's disease
• Arthritis
• Asthma
• Cancer
• COPD
• Diabetes
• Congestive Heart Failure
• High Blood Pressure
• High Cholesterol
• Obesity
• Osteoporosis
• Stroke

Demographics

• Age
• Sex
• Disabled
• Long Term Institutional Status (LTI Designated Status)

Genomes

• Human Genome]
• Microbiome (and other resident bacteria)
• Proteome - set of proteins expressed by a genome, cell, tissue or organism at a given time, under defined conditions.
• Metabolites - are small molecules with metabolism functions of fuel, structure, signaling, stimulatory and inhibitory effects on enzymes and other catalytic activities
• Tumors - abnormal mass of tissue as a result of abnormal growth or division of cells
• Viruses - small infectious agent that replicates only inside the living cells of other organisms

Immunizations

• Flu
• Tetanus

Impairments

• Cognitive Impairments (Delirium "confused state", Dementia)
• Developmental Challenges (Autism)
• Physical Impairments (Use of limbs, arthritis, amputation, birth defects, Epilepsy)
• Sensory Impairments (Blind or Visually Impaired, Deaf or Hard of Hearing, loss of taste and smell)

Medical History

• Adverse events
• Family Medical History
• Medical Conditions
• Surgeries

Physiological Metrics

• Blood glucose level
• Blood pressure
• Cholesterol level (HDL, LDL, etc)
• Heart rate

Problem lists

• Abdominal pain
• Acute asthma
• Chest Pain
• Fever
• Fractures
• Headache
• Pain (Chest Pain)
• Rash or skin infection
• Shortness of Breath
• Sprains
• Upper respiratory tract infection
• Wounds

Functional Conditions

Functional Conditions are elements of the clinical factors in patient recovery.

Basic Physical

The ten variables addressed in the Barthel scale are:

• presence or absence of fecal incontinence
• presence or absence of urinary incontinence
• help needed with grooming
• help needed with toilet use
• help needed with feeding
• help needed with transfers (e.g. from chair to bed)
• help needed with walking
• help needed with dressing
• help needed with climbing stairs
• help needed with bathing

Basic Life Activities

• Clean home or setting
• Drive
• Laundry
• Prepare food and/or cook
• Shopping (Food, Medicines, necessities, etc.)
• Use Public Transportation,

Logistic Capabilities

• Walk - able to walk, ride in car, ride bus or taxi
• Assisted Walking - walker, cane
• Wheelchair - Travel via Wheelchair
• Equipment Requirements - Oxygen, heart device, etc.

Work

Physically able to go back to work or enough functional ability to find a new job

Passion

Physically able to go back to work or enough functional ability to find a new job

• Volunteer, watch grand kids soccer games, etc.
• Golf, weekly lunches with friends, etc.

Mental

Not prevented from working, pursuing passion and functional activities because of mental health challenges

• Fear, confidence in certain situations, etc.