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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Project description:BACKGROUND AND PURPOSE (AIMS):Measurement error of intraoral quantitative sensory testing (QST) has been assessed using traditional methods for reliability, such as intraclass correlation coefficients (ICCs). Most studies reporting QST reliability focused on assessing one source of measurement error at a time, e.g., inter- or intra-examiner (test-retest) reliabilities and employed two examiners to test inter-examiner reliability. The present study used a complex design with multiple examiners with the aim of assessing the reliability of intraoral QST taking account of multiple sources of error simultaneously. METHODS:Four examiners of varied experience assessed 12 healthy participants in two visits separated by 48h. Seven QST procedures to determine sensory thresholds were used: cold detection (CDT), warmth detection (WDT), cold pain (CPT), heat pain (HPT), mechanical detection (MDT), mechanical pain (MPT) and pressure pain (PPT). Mixed linear models were used to estimate variance components for reliability assessment; dependability coefficients were used to simulate alternative test scenarios. RESULTS:Most intraoral QST variability arose from differences between participants (8.8-30.5%), differences between visits within participant (4.6-52.8%), and error (13.3-28.3%). For QST procedures other than CDT and MDT, increasing the number of visits with a single examiner performing the procedures would lead to improved dependability (dependability coefficient ranges: single visit, four examiners=0.12-0.54; four visits, single examiner=0.27-0.68). A wide range of reliabilities for QST procedures, as measured by ICCs, was noted for inter- (0.39-0.80) and intra-examiner (0.10-0.62) variation. CONCLUSION:Reliability of sensory testing can be better assessed by measuring multiple sources of error simultaneously instead of focusing on one source at a time. In experimental settings, large numbers of participants are needed to obtain accurate estimates of treatment effects based on QST measurements. This is different from clinical use, where variation between persons (the person main effect) is not a concern because clinical measurements are done on a single person. IMPLICATIONS:Future studies assessing sensory testing reliability in both clinical and experimental settings would benefit from routinely measuring multiple sources of error. The methods and results of this study can be used by clinical researchers to improve assessment of measurement error related to intraoral sensory testing. This should lead to improved resource allocation when designing studies that use intraoral quantitative sensory testing in clinical and experimental settings.

Project description:Reactive agility (RAG) and change of direction speed (CODS) are important determinants of success in football (soccer), but there is an evident lack of information on reliable and valid football-specific testing procedures which will be applicable in defining sport-specific RAG and CODS in youth players. This study evaluated reliability and construct validity of newly developed tests of football-specific RAG (FS_RAG) and CODS (FS_CODS), which involved the ball kicking football technique. Additionally, factors associated with FS_RAG and FS_CODS were evaluated. The participants were youth football players (n = 59; age: 13.40 ± 1.25 years) divided according to their age into U13 (11-12 years of age; n = 29), and U15 (13-14 years of age; n = 30) categories. Additionally, performance levels (starters [first-team] vs. non-starters [substitutes]) were observed in each age category. The dependent variables were newly developed FS_RAG and FS_CODS tests. The independent variables were sprinting capacities over 10 and 20 meters (S10M, S20M), countermovement jump (CMJ), the reactive strength index (RSI), and a generic CODS test of 20 yards (20Y). The newly developed FS_CODS and FS_RAG were observed as dependent variables. Results showed appropriate intra-testing and inter-testing reliability of the FS_RAG and FS_CODS, with somewhat better reliability of the FS_CODS (ICC=0.82 and 0.79, respectively). Additionally, better reliability was evidenced in U15 than in U13 (ICC: 0.82-0.85, and 0.78-0.80 for U15 and U13, respectively). Independent samples t-test indicated significant differences between U13 and U15 in S10 (t-test: 3.57, p < 0.001), S20M (t-test: 3.13, p < 0.001), 20Y (t-test: 4.89, p < 0.001), FS_RAG (t-test: 3.96, p < 0.001), and FS_CODS (t-test: 6.42, p < 0.001), with better performance in U15. Starters outperformed non-starters in most capacities among U13, but only in FS_RAG among U15 (t-test: 1.56, p < 0.05). Multiple regression calculations indicated nonsignificant association between independent and dependent variables in U13 (FS_CODS: 19%, FS_RAG: 21% of the explained variance, both p > 0.05), but independent variables explained significant proportion of both dependent variables in U15 (FS_CODS: 35%, FS_RAG: 33% explained variance, both p < 0.05). The study confirmed the applicability of newly developed tests in distinguishing studied age categories of players. Results indicate that superiority in all studied fitness capacities is translated into performance level in U13. Meanwhile, FS_RAG seems to be important determinant of quality in U15.

Dataset Information

ACSC Indicator: testing reliability for hypertension.

Background

Methods

Results

Conclusions

Publications

ACSC Indicator: testing reliability for hypertension.

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