Dataset Information

ACSC Indicator: testing reliability for hypertension.

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 (??=?0.092). The ? also remained low when assessing agreement between raters 1 and 3 (??=?0.092), but the ? was lower (less than chance agreement) for raters 1 and 2 (??=?-0.119) and raters 2 and 3 (??=?-0.008). When the 5-point scale was dichotomized, there was fair agreement among three raters (??=?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.

SUBMITTER: Walker RL

PROVIDER: S-EPMC5485699 | biostudies-literature | 2017 Jun

REPOSITORIES: biostudies-literature

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Publications

ACSC Indicator: testing reliability for hypertension.

Walker Robin L RL Ghali William A WA Chen Guanmin G Khalsa Tej K TK Mangat Birinder K BK Campbell Norm R C NRC Dixon Elijah E Rabi Doreen D Jette Nathalie N Dhanoa Robyn R Quan Hude H

BMC medical informatics and decision making 20170626 1

<h4>Background</h4>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.<h4>Methods</h4>We applied the Canadian Institute for Health Information's case definition to obtain a random sample of patients who had an ACSC hospital ...[more]

PMID: 28651587

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Dataset Information

ACSC Indicator: testing reliability for hypertension.

Background

Methods

Results

Conclusions

Publications

ACSC Indicator: testing reliability for hypertension.

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