ACSC Indicator: testing reliability for hypertension

BMC Medical Informatics and Decision Making

Robin L. Walker¹  Doreen Rabi¹  Nathalie Jette¹  Elijah Dixon¹  Hude Quan¹  William A. Ghali¹  Norm R. C. Campbell¹  Guanmin Chen¹  Birinder K. Mangat²  Tej K. Khalsa²  Robyn Dhanoa³ 

[1] Department of Community Health Sciences, University of Calgary;Department of Medicine, University of Calgary;Faculty of Nursing, University of Calgary;

关键词: Ambulatory care sensitive conditions;    Reliability;    Quality indicator;    Primary care;    Avoidable hospitalizations;   

DOI  :  10.1186/s12911-017-0487-4

来源: DOAJ

【 摘 要 】

Abstract Background With high-quality community-based primary care, hospitalizations for ambulatory care sensitive conditions (ACSC) are considered avoidable. The purpose of this study was to test the inter-physician reliability of judgments of avoidable hospitalizations for one ACSC, uncomplicated hypertension, derived from medical chart review. Methods We applied the Canadian Institute for Health Information’s case definition to obtain a random sample of patients who had an ACSC hospitalization for uncomplicated hypertension in Calgary, Alberta. Medical chart review was conducted by three experienced internal medicine specialists. Implicit methods were used to judge avoidability of hospitalization using a validated 5-point scale. Results There was poor agreement among three physicians raters when judging the avoidability of 82 ACSC hospitalizations for uncomplicated hypertension (κ = 0.092). The κ also remained low when assessing agreement between raters 1 and 3 (κ = 0.092), but the κ was lower (less than chance agreement) for raters 1 and 2 (κ = -0.119) and raters 2 and 3 (κ = -0.008). When the 5-point scale was dichotomized, there was fair agreement among three raters (κ = 0.217). The proportion of ACSC hospitalizations for uncomplicated hypertension that were rated as avoidable was 32.9%, 6.1% and 26.8% for raters 1, 2, and 3, respectively. Conclusions This study found a low proportion of ACSC hospitalization were rated as avoidable, with poor to fair agreement of judgment between physician raters. This suggests that the validity and utility of this health indicator is questionable. It points to a need to abandon the use of ACSC entirely; or alternatively to work on the development of explicit criteria for judging avoidability of hospitalization for ACSC such as hypertension.

【 授权许可】

Unknown