[A reproducibility and validity study of a systematic review on ischemic cardiopathy. The Study Group of the Quality of Care (GRECA)]. / Estudio de la reproducibilidad y validez de una revisión sistemática sobre cardiopatía isquémica. Grupo de Estudio de la Calidad Asistencial (GRECA).

BACKGROUND: The systematic literature reviews have been proposed as a method of scientific evidence identification since they protect the final product from the subjectivity of each primary source reviewer. However, it is not known whether the different ways of evidence synthesis accomplish suitable criteria of objectivity, reliability and biases protection so as to be considered scientifically valid. An experiment of reliability and validity of a systematic literature review about coronary heart disease was carried out. MATERIAL AND METHODS: Study of blind concordance between two independent reviewers for the identification, selection, retrieval and quality evaluation of the articles by using the same protocol. The concordance was analysed by the kappa index for two observers in different categories. The validity was evaluated throughout the acceptability of the review users. RESULTS: The concordance for their identification capacity was poor although they used the same key words (869 versus 476). But the concordance improved when considering selection (26.6% versus 29.2%), retrieval (agreement = 76%) classification by kind of article (kappa = 0.60) and scoring by strength of the evidence (kappa = 0.87). The acceptability was high among review users. CONCLUSIONS: It would be assumed that, even under tight rules of performance, the systematic literature reviews are not completely protected against some biases which could damage their validity in a non easily controllable form. The implication of reviewers, experts in documentation and users of the literature, together with pilot studies performed previous to the review, seems to be the best way to yield better results.

[Are the guidelines guiding us reliable? Evaluation of the Spanish clinical practice guidelines]. / Las guías que nos guían son fiables? Evaluación de las guías de práctica clínica españolas.

BACKGROUND AND OBJECTIVE: There is a large proliferation of clinical practice guidelines (CPG), there being doubts on inconsistencies between the recommendations made and internal incongruencies, that affect the role of the guidelines as instruments helping the clinicians. This study aims to analyze the quality of a group of Spanish CPG and to assess the feasibility of use and consistency of the AGREE Instrument in its Spanish version, designed to evaluate the CPG. METHOD: A total of 278 CPG produced in Spain between January 1990 and December 2002 were identified. The originals of 61 guidelines were recovered from their authors and passed to the AGREE Instrument independently by four raters. Quality of the guidelines feasibility and reproducibility of AGREE were analyzed. RESULTS: For all the attributes of AGREE except in the editorial independence, more than 60% of the guidelines evaluated obtained a poor quality score, there being no domain in which more than 10% of the guidelines was excellent. The worst grading areas are those of applicability, participation and rigour of development of the guidelines. Of the 61 guidelines evaluated, the reviewers graded 25 as "very poor quality", 26 as "non recommendable" and 6 and 4 as "recommendable" or "highly recommendable", respectively. Interrater consistency was high. CONCLUSIONS: The mean quality of the Spanish guidelines evaluated is very low. The AGREE Instrument in its Spanish version is consistent for the Spanish guidelines and easy to use.

[Hospital discharge reports may be an inadequate source of information to evaluate care quality]. / Los informes de alta hospitalaria médica pueden ser una fuente insuficiente de información para evaluar la calidad de la asistencia.

OBJECTIVES: To examine whether there is adequate available information in hospital discharge records (HDR) to retrospectively evaluate the adequacy of medical care to patients suffering from ischemic heart disease (IHD) and to relate care quality to physicians' decisions. MATERIAL AND METHODS: Cross-sectional study in which a total of 690 HDRs of patients admitted to three university teaching hospitals in Seville, Spain, on account of ischemic heart disease. The fulfillment of 15 parameters representing an adaptation to the CMBD regulation to IHD. The criterion of adequate information was set at 80% of data. RESULTS: Only 2.8% of HDRs contains adequate information. According to the analysed data, relevant fulfillment variability was observed. There were significant differences in fulfillment depending upon hospital and type of patient, with more information among younger patients and comorbidity. CONCLUSIONS: HDRs contain inadequate information to evaluate medical care.

[Medical history in the assessment of quality of care in ischemic cardiopathy: is it a valid information source?]. / La historia clínica en la evaluación de la calidad asistencial de la cardiopatía isquémica: es una fuente de información válida?

OBJECTIVE: To examine the availability of information in the clinical records (CR) to evaluate care quality in ischemic heart disease. MATERIAL AND METHODS: A total of 722 clinical records of patients admitted because of ischemic heart disease were evaluated. Based upon a bibliographic review and the criteria of an expert panel necessary data to evaluate care quality were selected. A CR was considered adequate when at least 80% of data considered necessary by the expert panel were available. RESULTS: 78.5% of CR had adequate data. The elderly, clinical presentation as ischemic equivalent and one of the hospitals studied had most deficient CR. CONCLUSIONS: The CR is valid to retrospectively evaluate medical care. Differences between hospitals were important and should be taken into consideration before studies on clinical quality are performed.