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BMC Medical Informatics and Decision Making
Published in: BMC Medical Informatics and Decision Making 1/2017

Open Access 01-12-2017 | Research article

ACSC Indicator: testing reliability for hypertension

Authors: Robin L. Walker, William A. Ghali, Guanmin Chen, Tej K. Khalsa, Birinder K. Mangat, Norm R. C. Campbell, Elijah Dixon, Doreen Rabi, Nathalie Jette, Robyn Dhanoa, Hude Quan

Published in: BMC Medical Informatics and Decision Making | Issue 1/2017

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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.
Appendix
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Metadata
Title
ACSC Indicator: testing reliability for hypertension
Authors
Robin L. Walker
William A. Ghali
Guanmin Chen
Tej K. Khalsa
Birinder K. Mangat
Norm R. C. Campbell
Elijah Dixon
Doreen Rabi
Nathalie Jette
Robyn Dhanoa
Hude Quan
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Medical Informatics and Decision Making / Issue 1/2017
Electronic ISSN: 1472-6947
DOI
https://doi.org/10.1186/s12911-017-0487-4

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