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2013, Number 3

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Revista Cubana de Salud Pública 2013; 39 (3)

Validation of the severity of illness index of the clinical services in neurology,

Tamargo BTO, Jiménez PRE, Terry VO, Álvarez RJM

Language: Spanish
References: 33
Page: 426-439
PDF size: 182.11 Kb.


ABSTRACT

Introduction: in the comparative analysis of the hospital performance based on the health outcome indicators, the severity of illness has become an important confounding factor.
Objective: to assess the validity and reliability of the clinical severity of illness index of the "Hermanos Ameijeiras" hospital.
Methods: retrospective and descriptive research at the neurological department at the cited hospital. The source of information was the medical histories of 329 patients discharged from the hospital. After applying the exclusion criteria, the final sample was made up of 277 histories from which the necessary data were drawn. The analyzed period covered January to November 2008.
Results: in terms of conceptual validity, the state on discharge and the quantitative severity of illness index were related. The criterium quality showed Kappa's statistic of 0.4998 (IC de 95 % 0.4160-0.5837) and a correlation coefficient between Horne's disease severity index and the quantitative severity index of the hospital equals to 0.72 (p‹ 0.001). The interrater agreement revealed a reliability coefficient of 0.86 and a global weighted Kappa coefficient of 0.75. Cronbach's alpha coefficient was 0.62
Conclusions: the severity of illness index of the clinical services at the neurological service of "Hermanos Ameijeiras" hospital is acceptable in terms of validity and reliability, which makes it useful for an objective classification of the severe condition of a patient.


REFERENCES

  1. Tamargo Barbeito TO, Jiménez Paneque RE, Álvarez Rodríguez JM, Terry Villa O. Utilidad del Índice de Gravedad de Servicios Clínicos del Hospital Hermanos Ameijeiras. Rev Cubana Salud Pública. 2013 [citado 2 Abr 2013];39(1):4-18. Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0864- 34662013000100002&lng=es

  2. Levy MM, Rapoport J, Lemeshow S, Chalfin DB, Phillips G, Danis M. Association between Critical Care Physician Management and Patient Mortality in the Intensive Care Unit. Ann Intern Med. 2008;148:801-9.

  3. Peiró S, Librero J. Evaluación de calidad a partir del conjunto mínimo de datos básicos al alta hospitalaria. Rev Neurol. 1999;29:651-61.

  4. Iezzoni LI. Risk adjustment for measuring healthcare outcomes. 2nd ed. Chicago, Illinois: Health Administration Press; 1997.

  5. Iezzoni LI. Risk and Outcomes. In: Iezzoni LI, editor. Risk adjustment for measuring healthcare outcomes. 2nd ed. Chicago: Illinois, Health Administration Press; 1997. p. 1-41.

  6. Iezzoni LI. The risk of risks adjustment . Special Communications. JAMA. 1997;278(19):325-43.

  7. Tamargo Barbeito TO, Jiménez Paneque RE. El ajuste por riesgo en la evaluación del desempeño hospitalario. Rev Cubana Salud Pública. 2009 [citado 13 Ago 2009];35(3). Disponible en: http://www.bvs.sld.cu/revistas/spu/vol35_3_09/spu10309.htm

  8. Iezzoni LI. Developing Risk-Adjustment Methods. En: Iezzoni LI, editor. Risk adjustment for measuring healthcare outcomes. 2nd ed. Chicago, Illinois: Health Administration Press; 1997. p. 279-329.

  9. Martins M, Blais R, da Costa Leite I. Mortalidade hospitalar e tempo de permanência: comparação entre hospitais públicos e privados na região de Ribeirão Preto, São Paulo, Brasil. Cad Saúde Pública. 2004;20(Sup 2):268-82.

  10. Jiménez R, Domínguez E, López L, Fariñas H. Difference between observed and predicted length of stay as indicator of patient care inefficiency. Internat J Quality Health Care. 1999;11(5):375-84.

  11. Horn SD, Horn RA. Reliability and validity of the severity of illness index. Med Care. 1986;24(2):159-78.

  12. Moya del Madrigal L. Aplicación del grupos del los grupos de diagnósticos relacionados a la gestión del sistema nacional del servicios de la hospitalización del la CCSS. Rev Cienc Adm Financ Segur Soc. 1998;6(2):13-33.

  13. Librero J, Marín M, Peiró S, Verdaguer Manujos A. Exploring the impact of complications on length of stay in major surgery diagnosis-related groups. Internat J Quality Health Care. 2004;16:51-7.

  14. Gonnella JS, Hornbrook ML, Louis DZ. Staging of disease. A case-mix measurement. JAMA. 1984;251:637-46.

  15. Myers RP, Quan H, Hubbard JN, Shaheen AA, Kaplan GG. Predicting in-hospital mortality in patients with cirrhosis: results differ across risk adjustment methods. Hepatology. 2009;49(2):568-77.

  16. Smith KD, Yuen EJ, Louis DZ, Rabinowitz C, Maio V, Jimbo M. Risk adjustment in a non-market based system. The case of Emilia-Romagna, Italy. Internat J Technol Management. 2006;7(1/2):100-15.

  17. Li B, Evans D, Faris P, Stafford D, Quan H. Risk adjustment performance of Charlson and Elixhauser comorbidities in ICD-9 and ICD-10 administrative databases. BMC Health Ser Res. 2008 [cited 2009 Mar 20];8:12. Available from: http://www.biomedcentral.com/content/pdf /1472-6963-8-12.pdf

  18. Zhu H, Hill MD. The Elixhauser Index for comorbidity adjustment of in-hospital case Fatality. Neurology. 2008;71:2837.

  19. Jiménez RE, Vázquez J, Fariñas H. Construcción y validación de un índice de gravedad para pacientes hospitalizados en áreas clínicas. Gac Sanit, Xunta de Galicia. 1997;11:122-30.

  20. Jiménez RE, Lam RM, Marot M, Delgado A. Observed-predicted length of stay for an acute psychiatric department, as an indicator of inpatient care inefficiencies. Retrospective case-series study. BMC Health Serv Res. 2004 [cited 2007 Mar 20];4(4). Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=387834

  21. Ferreira A, Rígoli F, Bazzani R. Procesos asociados con el tiempo de estadía en el Hospital de Clínicas: estudio en cuatro enfermedades trazadoras. Rev Med Uruguay. 1997;13:23-36.

  22. Liu Y, Phillips M, Codde J. Factors influencing patients' length of stay. Aust Health Rev. 2001;24(2):63-70.

  23. Sánchez R, Echeverri J. Validación de escalas de medición en salud. Rev Salud Pública. 2004;6(3):302-18.

  24. Fleiss JL. The measurement of interrater agreement. En: Fleiss JL, editor. Statistical methods for rates and proportions. 2nd ed. New York: John Wiley and Sons;1981. p. 212-36.

  25. López de Ullibari Galparsoro I, Pita Fernández. Medidas de concordancia: el índice de Kappa. Cad Aten Primaria. 1999;6:169-71.

  26. Cerda J, Villarroel L. Evaluación de la concordancia inter-observador en investigación pediátrica: Coeficiente de Kappa. Rev Chil Pediatr. 2008;79(1):54-8.

  27. Schmitz-Hübsch T, Tezenas du Montcel S, Baliko L, Berciano J, Boesch S, Depondt C, et al. Scale for the assessment and rating of ataxia. Development of a new clinical scale. Neurology. 2003;66(1):1711-20.

  28. Calvo-Gómez JM, Sánchez-Pedraza R, Jaramillo-González LE, Tarcisio-Mantilla C. Validación de una Escala para Evaluación de Síntomas Colaterales Extrapiramidales de Simpson-Angus. Rev Salud Pública. 2006;8(1):74-87.

  29. Sierra JC, Guillén-Serrano V, Santos-Iglesias P. Insomnia Severity Index: algunos indicadores acerca de su fiabilidad y validez en una muestra de personas mayores. Rev Neurol. 2008;47(11):566-70.

  30. Streiner DL, Norman GR. Health measurement scales. A practical guide to their development and use. Oxford: Oxford University Press; 1989.

  31. Pita Fernández S, Pértega Díaz S., Rodríguez Maseda E. La fiabilidad de las mediciones clínicas: el análisis de concordancia para variables numéricas. Cad Aten Primaria. 2003;10(4):290-6.

  32. Bland JM, Altman DG. Statistics Notes: Cronbach's Alpha. BMJ. 1997;314:572.

  33. Feinstein AR. Clinimetrics. New Haven: Yale University Press; 1987.




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