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21, 22 Each ADG is a grouping of diagnosis codes similar in terms of severity and likelihood of persistence of the health condition treated over a relevant period; ADGs are not mutually exclusive, and individuals can have up to 32 ADGs. Individuals are then placed into 1 of 93 discrete ACG categories according to their assigned ADGs, age and sex. A standardized predicted resource index expresses anticipated resource use as a relative value, with the mean rescaled to one; higher value represents higher morbidity burden and thus higher medical utilization.

An individual's change in three-level morbidity burden over 3 years was assigned to one of the following six trajectory groups, using the classification system applied in prior research: constant-high, constant-medium, constant-low, decreasing, increasing and erratic ( Supplementary data, Appendix A ). 20 Risk-adjustment models.