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ACSC Indicator: testing reliability for hypertension.

Robin L Walker¹, William A Ghali^1,2,3, Guanmin Chen^1,2

¹Department of Community Health Sciences, University of Calgary, 3280 Hospital Dr. NW, Calgary, AB, T2N 4Z6, Canada.

BMC Medical Informatics and Decision Making

|June 28, 2017

Summary

Physician agreement on avoidable hospitalizations for uncomplicated hypertension was poor. This suggests the health indicator

Keywords:

Ambulatory care sensitive conditions Avoidable hospitalizations Primary care Quality indicator Reliability

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Area of Science:

Healthcare quality assessment
Primary care effectiveness
Health services research

Background:

Ambulatory care sensitive conditions (ACSC) hospitalizations are considered avoidable with high-quality primary care.
Assessing the avoidability of these hospitalizations is crucial for evaluating healthcare system performance.

Purpose of the Study:

To evaluate the inter-physician reliability of judgments regarding avoidable hospitalizations for uncomplicated hypertension, an Ambulatory Care Sensitive Condition (ACSC).

Main Methods:

A random sample of 82 patients hospitalized for uncomplicated hypertension (an ACSC) in Calgary, Alberta, was reviewed.
Three internal medicine specialists used implicit methods and a validated 5-point scale to judge the avoidability of each hospitalization.
Inter-rater reliability was assessed using Cohen's kappa (κ) statistic.

Main Results:

Overall agreement among the three physicians was poor (κ = 0.092).
Agreement was particularly low between two pairs of raters (κ = -0.119 and κ = -0.008), indicating agreement less than chance.
When the scale was dichotomized, fair agreement was observed (κ = 0.217), with reported avoidable proportions varying significantly among physicians (6.1% to 32.9%).

Conclusions:

There is poor to fair agreement among physicians when judging the avoidability of hospitalizations for uncomplicated hypertension.
The validity and utility of using ACSC hospitalizations as a health indicator are questionable due to low inter-rater reliability.
Development of explicit criteria for judging avoidability of ACSC hospitalizations is recommended, or consideration should be given to abandoning this indicator.