Validez predictiva del Clinical Risk Groups en pacientes crónicos en el ambito de la atencion primaria

Abstract

ObjectiveTo analyse a prediction model for admissions and hospital emergencies based on Clinical Risk Groups, in a population of complex chronic patients demanding primary care. DesignA multicentric retrospective observational study, of a cohort of chronic patients with comorbidity, from January until December 2013. PlaceThe study population was assigned to the Santa Pola and Raval health centres from the Health Department of Elche. ParticipantsCohort of chronic patients with comorbidity, from January to December 2013. InterventionsData about the number of admissions, reasons and complexity level associated with the admission were collected by the review of medical records. Main measuresTo determine the level of complexity, the classification included in the chronicity strategy of the Valencian Community based on Clinical Risk Groups was used. ResultsFive hundred and four patients were recruited with a high complexity degree (N3) and 272 with moderate/low complexity (N1–N2). A higher comorbidity was observed in N3 patients with high complexity [Charlson 2.9 (DE 1.8) vs. 1.9 (DE 1.3); P<.001], and higher dependence degree for basic diary activities [Barthel 16.1 (n=81) vs. 7.3 (n=20); P<.001].Association between the number of admissions [0.4 (DE 0.8) vs. 0.1 (DE 0.5); P<.001] and emergency visits [0.8 (DE 1.5) vs. 0.3 (DE 0.8), P<.001] was significatively higher in patients from N3 group than N1-N2 groups. ConclusionsThe predictive capacity of CRG grouper showed high sensibility for the patient classification with a high degree of complexity. Its specificity and positive predictive value were lower for the association of the N3 complexity stratum.