Abstract
BackgroundAdjusted clinical groups (ACG®) have been widely used to adjust resource distribution; however, the relationship with effectiveness has been questioned. The purpose of the study was to measure the relationship between efficiency assessed by ACG® and a clinical effectiveness indicator in adults attended in Primary Health Care Centres (PHCs).MethodsResearch design: cross-sectional study. Subjects: 196, 593 patients aged >14 years in 13 PHCs in Catalonia (Spain). Measures: Age, sex, PHC, basic care team (BCT), visits, episodes (diagnoses), and total direct costs of PHC care and co-morbidity as measured by ACG® indicators: Efficiency indices for costs, visits, and episodes (costs EI, visits EI, episodes EI); a complexity or risk index (RI); and effectiveness measured by a general synthetic index (SI). The relationship between EI, RI, and SI in each PHC and BCT was measured by multiple correlation coefficients (r).ResultsIn total, 56 of the 106 defined ACG® were present in the study population, with five corresponding to 44.5% of the patients, 11 to 68.0% of patients, and 30 present in less than 0.5% of the sample. The RI in each PHC ranged from 0.9 to 1.1. Costs, visits, and episodes had similar trends for efficiency in six PHCs. There was moderate correlation between costs EI and visits EI (r = 0.59). SI correlation with episodes EI and costs EI was moderate (r = 0.48 and r = −0.34, respectively) and was r = −0.14 for visits EI. Correlation between RI and SI was r = 0.29.ConclusionsThe Efficiency and Effectiveness ACG® indicators permit a comparison of primary care processes between PHCs. Acceptable correlation exists between effectiveness and indicators of efficiency in episodes and costs.
Highlights
Adjusted clinical groups (ACG®) have been widely used to adjust resource distribution; the relationship with effectiveness has been questioned
Each patient is assigned to only one basic care team (BCT), and the general practice physician (GP) is responsible for managing primary care services for that patient, serving as the “gatekeeper” to the national health system
A total of 56 of the 106 defined ACG® were present in 196,593 patients, with 5 corresponding to 44.5% of the patients, 11 to 68.0% of patients, and 30 present in less than 0.5% of the population
Summary
Adjusted clinical groups (ACG®) have been widely used to adjust resource distribution; the relationship with effectiveness has been questioned. Patient classification systems were introduced more than 20 years ago in order to measure patient characteristics Of those developed for the hospital environment, Diagnosis Related Groups (DRG) are the most widely reported and used internationally [1]. In the primary health care centre (PHC) setting many aspects of these patient classification systems instruments are still in the research phase. They are beginning to be used in some Spanish regions as an aid to clinical. Adjusted Clinical Groups (ACG®) [5] is the most widely used of the systems developed for the PHC setting In this context, age is the variable normally used to adjust resource distribution. Type of disease may explain half of the variability in the use of resources, measured by frequency (visits or contacts), indirect use (referrals to specialists), and direct costs (diagnostic tests, analyses and drug prescriptions) [6,7,8]
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