Concordancia y utilidad de un sistema de estratificación para la toma de decisiones clínicas

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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.




González González, A. I., Miquel Gómez, A. M., Rodríguez Morales, D., Hernández Pascual, M., Sánchez Perruca, L., & Mediavilla Herrera, I. (2017). Concordancia y utilidad de un sistema de estratificación para la toma de decisiones clínicas. Atencion Primaria, 49(4), 240–247.

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