Skip to main content
Atencion Primaria logoLink to Atencion Primaria
. 2008 Nov 18;37(8):439–445. [Article in Spanish] doi: 10.1157/13088882

Aplicación retrospectiva de los grupos clínicos ajustados (ACG) en un centro de atención primaria

Retrospective application of adjusted clinical groups (ACGS) at a primary care centre

A Sicras-Mainar 1,
PMCID: PMC7679882  PMID: 16756843

Abstract

Objective

To evaluate retrospectively the application of adjusted clinical groups (ACGs) at a primary care centre.

Design

Descriptive, retrospective examination.

Setting

Urban.

Participants

All patients seen by the team in 2000 were included in the study. Those who moved or died during the study period were excluded.

Main measurements

Universal variables (age and sex), dependant variables (visits, episodes, and costs), and case-mix or comorbidity variables (ACGs 2.0) were measured. The model of cost per patient was established by distinguishing the costs of the PCC from the variables. The ICPC was converted to the ICD-9-CM and a multiple linear regression analysis was performed to predict the models.

Results

The total number of patients studied was 15 983, with an average of 5.0±3.2 episodes and 8.0±7.7 visits during the year. The power of explanation of the variability of the classification between the number of episodes was 71.9%; of the visits, 50.0% (with refinement, 56.3%); and cost, 30.2% (with refinement, 55.0%) (P=.000).

Conclusions

ACGs were shown to be an acceptable system for classifying patients according to the consumption of resources used in primary care. In addition, the methodology used was adequate for integrating clinical and economic information at the PCC.

Key words: Adjusted clinical groups, Resource use, Primary care, ACGs, Management, Information system

Bibliografía

  • 1.Elola J., Daponte A., Navarro V. Health indicators and the organization of Health care Systems in Western Europe. Am J Public Health. 1995;85:1397–1401. doi: 10.2105/ajph.85.10.1397. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 2.Varela J., Berenguer J., Alonso E., Manzanera R., Picas J.M. Los sistemas de información en Atención Primaria. Aten Primaria. 1988;5:543–547. [Google Scholar]
  • 3.Bolíbar B., Castillo A., Coderch J., Ruano I., Sicras A., Fusté J. Hacia la definición de un conjunto mínimo básico de datos de atención primaria. Aten Primaria. 2002;30:229–235. doi: 10.1016/S0212-6567(02)79014-8. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 4.Bolíbar B., Prados A., Gervás J., Juncosa S., Carrillo E. Sistemas de clasificación en grupos isoconsumo (case-mix) en atención ambulatoria. Perspectivas para nuestra atención ambulatoria. Aten Primaria. 1996;17:74–83. [PubMed] [Google Scholar]
  • 5.Juncosa S., Bolibar B. Un sistema de clasificación de pacientes para nuestra atención primaria: los ambulatory care groups (ACG) Gac Sanit. 1997;11:83–94. doi: 10.1016/s0213-9111(97)71280-9. [DOI] [PubMed] [Google Scholar]
  • 6.Starfield B., Weiner J., Mumford L., Steinwachs D. Ambulatory care groups: a categorization of diagnoses for research and management. Health Ser Res. 1991;26:53–74. [PMC free article] [PubMed] [Google Scholar]
  • 7.Weiner J.P., Starfield B.H., Steinwachs D.M., Mumford L.M. Development and application of a population-oriented measure of ambulatory care case-mix. Med Care. 1991;29:452–472. doi: 10.1097/00005650-199105000-00006. [DOI] [PubMed] [Google Scholar]
  • 8.Juncosa S., Bolibar B., Roset M., Martínez C. Influencia de la unidad de análisis en los estudios de utilización de recursos en atención primaria. Gac Sanit. 1999;13:53–61. doi: 10.1016/s0213-9111(99)71322-1. [DOI] [PubMed] [Google Scholar]
  • 9.Bolibar B., Juncosa S. The development of ambulatory care groups in primary care. Rev Neurol. 1999;29:667–669. [PubMed] [Google Scholar]
  • 10.Bolanos-Carmona V., Ocaña-Riola R., Prados-Torres A., Gutiérrez-Cuadra P. Variations in health services utilization by primary care patients. Health Serv Manage Res. 2002;15:116–125. doi: 10.1258/0951484021912888. [DOI] [PubMed] [Google Scholar]
  • 11.Carmona G., Prados A., Sánchez-Cantalejo E. Los grupos de atención ambulatoria. Resultados parciales del proyecto: evaluación del comportamiento de los grupos de atención ambulatoria en nuestro entorno de atención primaria. Gestión Hospitalaria. 1997;1:40–45. [Google Scholar]
  • 12.Hormigo A., García A.J., Martos F., García M.C., Montesinos A.C., Prados A. Evaluación retrospectiva del comportamiento de los grupos de cuidados ambulatorios en un centro de salud. Aten Primaria. 1998;21:36–42. [PubMed] [Google Scholar]
  • 13.Juncosa S., Bolíbar B., Roset M., Tome R. Performance of an ambulatory case mix system in primary care in Spain: ambulatory care groups (ACGs) European J Public Health. 1999;9:27–35. [Google Scholar]
  • 14.Orueta J.F., López de Munain J., Baez K., Aiarzaguena J.M., Aranguren J.I., Pedrero E. Application of the ambulatory care groups in the primary care of a European national health care system: does it work? Med Care. 1999;37:238–248. doi: 10.1097/00005650-199903000-00004. [DOI] [PubMed] [Google Scholar]
  • 15.Lamberts H., Wood M. Masson/SG; Barcelona: 1990. Clasificación Internacional de la Atención Primaria (CIAP). Clasificación de razones de consulta. [Google Scholar]
  • 16.Orden de la Generalitat de Catalunya de 22 de diciembre de 1995. Diari Oficial de la Generalitat de Catalunya. 1995; 2148:9689-90.
  • 17.García Cardona F., Molins Pérez G., Farré Pradell J. La contabilidad de costes en atención primaria y cartera de servicios. Aten Primaria. 1995;16:141–145. [PubMed] [Google Scholar]
  • 18.Durán J., Jodar G., Pociello V., Parellada N., Martín A., Pradas J. Reforma de la atención primaria de salud: resultados económicos, asistenciales y de satisfacción. Aten Primaria. 1999;23:474–478. [PubMed] [Google Scholar]
  • 19.Sackett D., Rosenberg W., Gray J., Haynes R.B., Richardson W.S. Evidence based medicine: what it is and what it isn’t. BMJ. 1996;312:71–72. doi: 10.1136/bmj.312.7023.71. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 20.López de Munain J., Grandes G., Orueta J.F. Importancia de la calidad de los datos en la validación del case-mix ACG. Aten Primaria. 1998;22:128. [PubMed] [Google Scholar]
  • 21.Weiner J., Starfield B., Stuart M., Powe N., Steinwachs D. Ambulatory care practice variation within a medicaid program. Health Serv Res. 1996;30:751–770. [PMC free article] [PubMed] [Google Scholar]
  • 22.Adams E.K., Bronstein J.M., Raskind-Hood C. Adjusted clinical groups: predictive accuracy for Medicaid enrollees in three states. Health Care Financ Rev. 2002;24:43–61. [PMC free article] [PubMed] [Google Scholar]
  • 23.Reid R.J., MacWilliam L., Verhulst L., Roos N., Atkinson M. Performance of the ACG case-mix system in two Canadian provinces. Med Care. 2001;39:86–99. doi: 10.1097/00005650-200101000-00010. [DOI] [PubMed] [Google Scholar]
  • 24.Juncosa S., Bolibar B. Fundació Salut, Empresa i Economia; Barcelona: 1999. Descripció, comportament, usos i metodologia d’utilització d’un sistema per mesurar la casuística en la nostra atenció primària: els ambulatory care groups. [Google Scholar]
  • 25.Rosen A.K., Loveland S.A., Rakovski C.C., Christiansen C.L., Berlowitz D.R. Do different case-mix measures affect assessments of provider efficiency? Lessons from the Department of Veterans Affairs. J Ambul Care Manage. 2003;26:229–242. doi: 10.1097/00004479-200307000-00006. [DOI] [PubMed] [Google Scholar]
  • 26.Wahls T.L., Barnett M.J., Rosenthal G.E. Predicting resource utilization in a veterans health administration primary care population: comparison of methods based on diagnoses and medications. Med Care. 2004;42:123–128. doi: 10.1097/01.mlr.0000108743.74496.ce. [DOI] [PubMed] [Google Scholar]
  • 27.Martinez C., Juncosa S., Roset M. ¿Está relacionada la gravedad con la utilización de recursos? Una exploración del Duke Severity of Illness Scale (DUSOI) Aten Primaria. 1998;22:285–292. [PubMed] [Google Scholar]
  • 28.Warner G., Hoenig H., Montez M., Wang F., Rosen A. Evaluating diagnosis-based risk-adjustment methods in a population with spinal cord dysfunction. Arch Phys Med Rehabil. 2004;85:218–226. doi: 10.1016/s0003-9993(03)00768-8. [DOI] [PubMed] [Google Scholar]
  • 29.Fishman P.A., Goodman M.J., Hornbrook M.C., Meenan R.T., Bachman D.J., O’Keeffe-Rosetti M.C. Risk adjustment using automated ambulatory pharmacy data: the RxRisk model. Med Care. 2003;41:84–99. doi: 10.1097/00005650-200301000-00011. [DOI] [PubMed] [Google Scholar]
  • 30.Meenan R.T., Goodman M.J., Fishman P.A., Hornbrook M.C., O’Keeffe-Rosetti M.C., Bachman D.J. Using risk-adjustment models to identify high-cost risks. Med Care. 2003;41:1301–1312. doi: 10.1097/01.MLR.0000094480.13057.75. [DOI] [PubMed] [Google Scholar]

Articles from Atencion Primaria are provided here courtesy of Elsevier

RESOURCES