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Aten Primaria. 2017 Apr;49(4):240-247. doi: 10.1016/j.aprim.2016.04.009. Epub 2016 Sep 1.

[Concordance and usefulness of a stratification system for clinical decision making].

[Article in Spanish]

Author information

1
Unidad de Apoyo Técnico, Gerencia Adjunta de Planificación y Calidad (GAPYC), Gerencia de Atención Primaria (GAP), REDISSEC, Madrid, España. Electronic address: aisabel.gonzalezg@salud.madrid.org.
2
Coordinación de la Estrategia de Atención a Pacientes con Enfermedades Crónicas en la Comunidad de Madrid, GAPYC, GAP, Madrid, España.
3
Dirección Técnica de Sistemas de Información, GAPYC, GAP, Madrid, España.
4
Dirección Técnica de Sistemas de Información Sanitaria, GAPYC, GAP, REDISSEC, Madrid, España.
5
Dirección Técnica de Procesos y Calidad, GAPYC, GAP, Madrid, España.

Abstract

OBJECTIVES:

1) To analyse concordance between the level of risk classification using the Adjusted Groups Morbidity (GMA) tool and the assigned level of intervention by general practitioners (GP). 2) To study the usefulness of the GMA tool as an aid in electronic medical records (EMR) for decision making.

DESIGN:

Cross-sectional observational study of concordance.

LOCATION:

Primary Care. Madrid Health Service.

PARTICIPANTS:

Twenty eight GPs. A sample of 840 patients assigned to participating GPs was selected by disproportionate stratified random sampling (0.65 kappa, 0.125 precision, 5% positive rate, 95% confidence level).

MAIN MEASUREMENTS:

Weighted Cohen Kappa index for the degree of concordance between the GMA tool and the GPs. The usefulness of the tool was assessed using an ad hoc developed questionnaire.

RESULTS:

Kappa weighted index obtained was 0.60 (95%CI: 0.55-0.65). In 3% of cases the disagreement was maximum. The GPs found that the grouping tool had been useful in 76% of cases.

CONCLUSION:

Moderate strength/good concordance; incorporating a grouping tool in the EMR helps as a reminder for taking more proactive/integrated decisions based on social and health needs of people with chronic diseases.

KEYWORDS:

Atención primaria; Chronic disease; Clasificación; Classification; Enfermedad crónica; Estratificación; Primary health care; Stratification

PMID:
27592535
DOI:
10.1016/j.aprim.2016.04.009
[Indexed for MEDLINE]
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