The Academy of Medical Sciences. (2018) Multimorbidity: a priority for global health. https://acmedsci.ac.uk/file-download/82222577. Accessed 15 June 2023.

Khunti K, Sathanapally H, Mountain P. Multiple long term conditions, multimorbidity, and co-morbidities: we should reconsider the terminology we use. BMJ. 2023;2327. https://doi.org/10.1136/bmj.p2327.

Rosbach M, Andersen JS. Patient-experienced burden of treatment in patients with multimorbidity - A systematic review of qualitative data. PLoS ONE. 2017;12(6):e0179916. https://doi.org/10.1371/journal.pone.0179916.

Article  PubMed  PubMed Central  Google Scholar 

Damarell RA, Morgan DD, Tieman JJ. General practitioner strategies for managing patients with multimorbidity: a systematic review and thematic synthesis of qualitative research. BMC Fam Pract. 2020;21(1):131. https://doi.org/10.1186/s12875-020-01197-8.

Article  PubMed  PubMed Central  Google Scholar 

Xu X, Mishra GD, Jones M. Evidence on multimorbidity from definition to intervention: an overview of systematic reviews. Ageing Res Rev. 2017;37:53–68. https://doi.org/10.1016/j.arr.2017.05.003.

Article  PubMed  Google Scholar 

Valderas JM, Starfield B, Sibbald B, Salisbury C, Roland M. Defining comorbidity: Implications for Understanding Health and Health Services. The Annals of Family Medicine. 2009;7(4):357–63. https://doi.org/10.1370/afm.983.

Article  PubMed  Google Scholar 

Lehnert T, Heider D, Leicht H, Heinrich S, Corrieri S, Luppa M, Riedel-Heller S, König H-H. Review: Health Care utilization and costs of Elderly persons with multiple chronic conditions. Med Care Res Rev. 2011;68(4):387–420. https://doi.org/10.1177/1077558711399580.

Article  PubMed  Google Scholar 

Marengoni A, Angleman S, Melis R, Mangialasche F, Karp A, Garmen A, Meinow B, Fratiglioni L. Aging with multimorbidity: a systematic review of the literature. Ageing Res Rev. 2011;10(4):430–9.

Article  PubMed  Google Scholar 

Tran PB, Kazibwe J, Nikolaidis GF, Linnosmaa I, Rijken M, Van Olmen J. Costs of multimorbidity: a systematic review and meta-analyses. BMC Med. 2022;20(1). https://doi.org/10.1186/s12916-022-02427-9.

Wammes JJG, van der Wees PJ, Tanke MAC, Westert GP, Jeurissen PPT. Systematic review of high-cost patients’ characteristics and healthcare utilisation. BMJ Open. 2018;8(9). https://doi.org/10.1136/bmjopen-2018-023113.

National Institute for Health and Care Excellence. (2016) Multimorbidity: clinical assessment and management. NICE guideline [NG56]. https://www.nice.org.uk/guidance/ng56/evidence/full-guideline-pdf-2615543103. Accessed 15 June 2023.

Council of the European Union. (2013) Document 12981/13, Annex IV. https://data.consilium.europa.eu/doc/document/ST%2012981%202013%20INIT/EN/pdf. Accessed 15 June 2023.

Bell C, Appel CW, Frølich A, Prior A, Vedsted P. Improving Health Care for patients with multimorbidity: a mixed-methods study to explore the feasibility and process of aligning scheduled outpatient appointments through collaboration between medical specialties. Int J Integr Care. 2022;22(1):17. https://doi.org/10.5334/ijic.6013.

Article  PubMed  PubMed Central  Google Scholar 

Calderón-Larrañaga A, Vetrano DL, Ferrucci L, Mercer SW, Marengoni A, Onder G, Eriksdotter M, Fratiglioni L. Multimorbidity and functional impairment-bidirectional interplay, synergistic effects and common pathways. J Intern Med. 2019;285(3):255–71. https://doi.org/10.1111/joim.12843.

Article  PubMed  Google Scholar 

Blakemore A, Hann M, Howells K, Panagioti M, Sidaway M, Reeves D, Bower P. Patient activation in older people with long-term conditions and multimorbidity: correlates and change in a cohort study in the United Kingdom. BMC Health Serv Res. 2016;16(1):582. https://doi.org/10.1186/s12913-016-1843-2.

Article  PubMed  PubMed Central  Google Scholar 

van der Aa MJ, van den Broeke JR, Stronks K, Plochg T. Patients with multimorbidity and their experiences with the healthcare process: a scoping review. J Comorb. 2017;7(1):11–21.

Article  PubMed  PubMed Central  Google Scholar 

Schiotz ML, Host D, Christensen MB, Dominguez H, Hamid Y, Almind M, Sorensen KL, Saxild T, Holm RH, Frolich A. Quality of care for people with multimorbidity - a case series. BMC Health Serv Res. 2017;17(1):745. https://doi.org/10.1186/s12913-017-2724-z.

Article  PubMed  PubMed Central  Google Scholar 

Verhoeff M, De Groot J, Burgers JS, Van Munster BC. Development and internal validation of prediction models for future hospital care utilization by patients with multimorbidity using electronic health record data. PLoS ONE. 2022;17(3):e0260829. https://doi.org/10.1371/journal.pone.0260829.

Article  PubMed  PubMed Central  Google Scholar 

Haime V, Hong C, Mandel L, Mohta N, Iezzoni LI, Ferris TG, Vogeli C. Clinician considerations when selecting high-risk patients for care management. Am J Manag Care. 2015;21(10):e576–82.

PubMed  Google Scholar 

Heins M, Korevaar J, Schellevis F, Rijken M. Identifying multimorbid patients with high care needs - a study based on electronic medical record data. Eur J Gen Pract. 2020;26(1):189–95. https://doi.org/10.1080/13814788.2020.1854719.

Article  PubMed  PubMed Central  Google Scholar 

Fuchs VR. Current challenges to Academic Health centers. JAMA. 2013;310(10):1021. https://doi.org/10.1001/jama.2013.227197.

Article  PubMed  Google Scholar 

Berkowitz SA, Pahira JJ. Accountable Care Organization Readiness and Academic Medical Centers. Acad Med. 2014;89(9):1210–5. https://doi.org/10.1097/acm.0000000000000365.

Article  PubMed  Google Scholar 

Goldstein BA, Navar AM, Pencina MJ, Ioannidis JP. Opportunities and challenges in developing risk prediction models with electronic health records data: a systematic review. J Am Med Inform Assoc. 2017;24(1):198–208. https://doi.org/10.1093/jamia/ocw042.

Article  PubMed  Google Scholar 

de Ruijter UW, Kaplan ZLR, Bramer WM, Eijkenaar F, Nieboer D, van der Heide A, Lingsma HF, Bax WA. Prediction models for future high-need high-cost Healthcare Use: a systematic review. J Gen Intern Med. 2022;37(7):1763–70. https://doi.org/10.1007/s11606-021-07333-z.

Article  PubMed  PubMed Central  Google Scholar 

Quinaz Romana G, Kislaya I, Cunha Gonçalves S, Salvador MR, Nunes B, Matias Dias C. Healthcare use in patients with multimorbidity. Eur J Public Health. 2019;30(1):16–22. https://doi.org/10.1093/eurpub/ckz118.

Article  Google Scholar 

Stange KC. The Problem of Fragmentation and the need for Integrative Solutions. Ann Fam Med. 2009;7(2):100–3. https://doi.org/10.1370/afm.971.

Article  PubMed  PubMed Central  Google Scholar 

Wammes JJG, Jeurissen P, Westert GP. (2016) 2015 International Profiles of Health Care Systems - The Dutch Health Care System https://www.commonwealthfund.org/sites/default/files/documents/___media_files_publications_fund_report_2016_jan_1857_mossialos_intl_profiles_2015_v7.pdf. Accessed December 28, 2023.

Folmer K, Mot E. (2003) Diagnosis and treatment combinations in Dutch hospitals. https://www.researchgate.net/publication/242185877_Diagnosis_and_treatment_combinations_in_Dutch_hospitals#fullTextFileContent. Accessed 3 July 2023.

Healthcare Cost and Utilization Project (HCUP). (2018) Beta Clinical Classifications Software (CCS) for ICD-10-CM/PCS. https://www.hcup-us.ahrq.gov/toolssoftware/ccs10/ccs10.jsp. Accessed 10 June 2023.

Dutch Hospital Data (n.d.) About us [Over ons]. https://www.dhd.nl/over-ons. Accessed 29 Dec 2023.

Moons KG, Altman DG, Reitsma JB, Ioannidis JP, Macaskill P, Steyerberg EW, Vickers AJ, Ransohoff DF, Collins GS. Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD): explanation and elaboration. Ann Intern Med. 2015;162(1):W1–73. https://doi.org/10.7326/M14-0698.

Article  PubMed  Google Scholar 

Harrison C, Britt H, Miller G, Henderson J. Examining different measures of multimorbidity, using a large prospective cross-sectional study in Australian general practice. BMJ Open. 2014;4(7):e004694–4. https://doi.org/10.1136/bmjopen-2013-004694.

Article  PubMed  PubMed Central  Google Scholar 

Das LT, Kaushal R, Garrison K, Carrillo V, Grinspan Z, Theis R, Shenkman E, Abramson E. Drivers of preventable high health care utilization: a qualitative study of patient, physician and health system leader perspectives. J Health Serv Res Policy. 2020;25(4):220–8. https://doi.org/10.1177/1355819619873685.

Article  PubMed  Google Scholar 

Ho IS-S, Azcoaga-Lorenzo A, Akbari A, Black C, Davies J, Hodgins P, et al. Examining variation in the measurement of multimorbidity in research: a systematic review of 566 studies. Lancet Public Health. 2021;6(8):e587–97. https://doi.org/10.1016/S2468-2667(21)00107-9.

Article  PubMed  Google Scholar 

Diederichs C, Berger K, Bartels DB. The measurement of multiple chronic diseases--a systematic review on existing multimorbidity indices. J Gerontol A Biol Sci Med Sci. 2011;66A(3):301–11. https://doi.org/10.1093/gerona/glq208.

Huntley AL, Johnson R, Purdy S, Valderas JM, Salisbury C. Measures of Multimorbidity and Morbidity Burden for Use in Primary Care and Community settings: a systematic review and guide. The Annals of Family Medicine. 2012;10(2):134–41. https://doi.org/10.1370/afm.1363.

Article  PubMed  Google Scholar 

Zou H, Hastie T. Regularization and variable selection via the elastic net. J R Stat Soc Series B Stat Methodol. 2005;67(2):301–20.

Article  MathSciNet  Google Scholar 

Chen T, Guestrin C. XGBoost. 22nd ACM SIGKDD International Conference on Knowledge Discovery and Data Mining. 2016. https://doi.org/10.1145/2939672.2939785. Accessed 3 July 2023.

Article  Google Scholar 

Menard S. (2002) Applied Logistic Regression Analysis https://doi.org/10.4135/9781412983433.

Breiman L. Random forests. Mach Learn. 2001;45(1):5–32. https://doi.org/10.1023/a:1010933404324.

Article  Google Scholar 

DeLong ER, DeLong DM, Clarke-Pearson DL. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics; 1988. pp. 837–45.

Steyerberg EW. Clinical prediction models. Statistics for biology and health [Internet]. 2019. https://doi.org/10.1007/978-3-030-16399-0.

Van Calster B, Vickers AJ. Calibration of risk prediction models. Med Decis Making. 2015;35(2):162–9. https://doi.org/10.1177/0272989x14547233.

Article  PubMed  Google Scholar 

Davis J, Goadrich M. (2006) The relationship between Precision-Recall and ROC curves. Proceedings of the 23rd international conference on Machine learning.

R Core Team. (2013) R: A language and environment for statistical computing.

Lundberg S, Lee S-I. A Unified Approach to interpreting model predictions. arXiv pre-print server; 2017.

Molnar C. (2023) Interpretable Machine Learning. A Guide for Making Black Box Models Explainable. https://christophm.github.io/interpretable-ml-book/. Accessed 10 June 2023.

Morawski K, Dvorkis Y, Monsen CB. Predicting hospitalizations from electronic health record data. Am J Manag Care. 2020;26(1):e7–e13. https://doi.org/10.37765/ajmc.2020.42147.

Article  PubMed  Google Scholar 

Fernández A, García S, Galar M, Prati RC, Krawczyk B, Herrera F. Learning from imbalanced data sets. 2018. https://link.springer.com/book/10.1007/978-3-319-98074-4.

Hudon C, Courteau J, Chiu YM, Chouinard M-C, Dubois M-F, Dubuc N, Elazhary N, Racine-Hemmings F, Dufour I, Vanasse A. (2020) Risk of frequent Emergency Department Use among an Ambulatory Care Sensitive Condition Population: a Population-based Cohort Study. Med Care, 58(3).