Validación clínica de 2 agrupadores de morbilidad en el ámbito de atención primaria

INTRODUCTION: Adjusted Morbidity Groups (GMAs) and the Clinical Risk Groups (CRGs) are population morbidity based stratification tools which classify patients into mutually exclusive categories. OBJETIVE: To compare the stratification provided by the GMAs, CRGs and that carried out by the evaluators according to the levels of complexity. DESIGN: Random sample stratified by morbidity risk. LOCATION: Catalonia. PARTICIPANTS: Forty paired general practitioners in the primary care, matched pairs. INTERVENTIONS: Each pair of evaluators had to review 25 clinical records. MAIN OUTPUTS: The concordance by evaluators, and between the evaluators and the results obtained by the 2 morbidity tools were evaluated according to the kappa index, sensitivity, specificity, and positive and negative predicted values. RESULTS: The concordance between general practitioners pairs was around the kappa value 0.75 (mean value = 0.67), between the GMA and the evaluators was similar (mean value = 0.63), and higher than for the CRG (mean value = 0.35). The general practitioners gave a score of 7.5 over 10 to both tools, although for the most complex strata, according to the professionals’ assignment, the GMA obtained better scores than the CRGs. The professionals preferred the GMAs over the CRGs. These differences increased with the complexity level of the patients according to clinical criteria. Overall, less than 2% of serious classification errors were found by both groupers. CONCLUSION: The evaluators considered that both grouping systems classified the studied population satisfactorily, although the GMAs showed a better performance for more complex strata. In addition, the clinical raters preferred the GMAs in most cases.