Diseño y validación del Índice de Evaluación de Casos Complejos (IECC), un instrumento para identificar pacientes complejos
DOI:
https://doi.org/10.23938/ASSN.0946Palabras clave:
Enfermedad crónica, Comorbilidad, Complejidad del paciente, Psicometría, Reproducibilidad de los resultadosResumen
Fundamento. Desarrollar y validar un instrumento específico de identificación de pacientes complejos, el Índice de Evaluación de Casos Complejos (IECC).
Métodos. Estudio instrumental con dos fases: 1) Elaboración del instrumento: se definieron y operacionalizaron las variables extraídas de la literatura que, posteriormente, fueron sometidas al juicio de expertos. El IECC incluyó catorce variables divididas en dos dimensiones: complejidad del manejo clínico y complejidad del manejo comunitario. 2) Estudio psicométrico: evaluación de la fiabilidad por equivalencia entre observadores (r Pearson), de la validez de criterio respecto al sistema de clasificación Clinical Risk Groups (CRG) y de la validez de constructo a través de grupos conocidos y a través del estudio de conglomerados jerárquicos. Los análisis se realizaron con el paquete estadístico SPSS.v.17.
Resultados. La fiabilidad entre observadores para la subescala clínica fue r = 0,97, para la subescala comunitaria r = 0,74 y para la puntuación total r = 0,89. El 88,4% (n = 458) de los 518 casos identificados como complejos por el IECC fueron categorizados por el sistema CRG en las categorías de más complejidad clínica (niveles 6 a 9). Los resultados sustentan la validez de constructo de la escala. El análisis de conglomerados mostró dos clusters diferentes, aunque relacionados.
Conclusión. El IECC es un índice breve y de fácil aplicación, con una buena adecuación conceptual y evidencias de su fiabilidad y validez dirigido a la detección de pacientes con necesidades complejas.
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