With PAT CAT version 3.3 and above we have introduced the following behaviour for a number of different patient statuses:
- If a duplicate patient is "Deceased" then virtual patient is marked as "Deceased"
- If any of the duplicate patients is status "Current", "Transient" or "Banned" then virtual patient is marked as "Active"
The Adjusted column is designed to remove duplicate patients i.e. it will count patients who have visited multiple practices in a PHN catchment only once.
Where a patient has records from multiple practices, a virtual patient record is created which combines the records into one (refer [Virtual Patient]). The number in the 'Adjusted' column will count the 'virtual' patient record for these patients rather than the separate records that have been uploaded .
The Adjusted column will give a more accurate count of patients in the PHN catchment in contrast to the PHN (or other Organisation) total column which includes all patients records that have been uploaded from the individual clinics, and hence patients who have visited more than one practice in an organisation's catchment will be counted more than once.
Adjusted Column without Practice Filters
When used for the whole catchment (no Practice filters) the Adjusted column will normally show a lower number than the PHN total column, as all patients are included and duplicates are removed. Based on observed numbers this can be between 10 and 25% less patients as visiting more than one practice is very common.
Occasionally though when using filters, the adjusted column can be higher than the total. Consider this example:
- A patient has visited multiple practices
- The patient has a diagnosis of Asthma recorded at one practice but not the other - this means the virtual patient has a diagnosis of Asthma
- The patient is an active patient (3 or more visits to one practice) at one practice but not the other - this means the virtual patient is an active patient
- Filter for Active patients with Asthma.
- The virtual patient meets the criteria for both but neither of the individual patient records do. When you apply the filter for Active patients with Asthma there will be none in the PHN Total column but one patient in the Adjusted column
Using this example, we can show how the Adjusted column can appear to have more patients then the Total practice population count. We have found these cases are rare and usually the differences in the counts are very small.
Adjusted Column with Practice Filters
When used with practice filters, the Adjusted column will include patients that have had any visit to the practice(s) selected. The data for the virtual patient may include data that has originated from another practice that is not part of the filter. This often has the effect of returning higher numbers in the Adjusted column compared to the PHN total column.
It should be noted that the virtual patient record, which is a combined record from multiple practices, provides a more complete picture of the patient than the data from one practice alone. This can provide very interesting insights when filtering for one practice alone as it enables a view of how much patient data has been recorded elsewhere and is missing from the practice’s own records.
In the example below the filters applied are for one practice and for patients with diabetes. The PHN total column shows there are 819 patients at the practice that meet this criteria but the Adjusted column shows 1061. This means there are 242 patients who have been diagnosed with diabetes at one or more other practices and the diagnosis is missing in the practice’s own records.
The practice actually has 1,061 patients with diabetes. This might be because there are patients that have come to the practice once for something minor so the history wasn’t recorded in detail and the diabetes diagnosis was never made, or for a number of other reasons.
The adjusted column was not designed for this function but it can provide interesting data as it enables the PAT CAT user to see information about patient groups that has been entered at other clinics than the one(s) filtered for. It does not provide information where the information was entered, but it might still be useful for some research.
Generally we don't recommend to use the adjusted data for reporting when filtering by practice(s), but as the above example shows, there can be valuable information gained from this report when filtering for one practice.