title: Relationship between efficiency and clinical effectiveness indicators in an adjusted model of resource consumption: a cross-sectional study.
abstract: BACKGROUND
  Adjusted 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).
  
  
  METHODS
  
  
  
  METHODS
  cross-sectional study.
  
  
  METHODS
  196, 593 patients aged >14 years in 13 PHCs in Catalonia (Spain).
  
  
  METHODS
  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).
  
  
  RESULTS
  In 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.
  
  
  CONCLUSIONS
  The 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.
authors.affiliation: Institut Universitari d'investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Av, Gran Via de les Corts Catalanes, 587 Àtic, 08007 Barcelona, Spain. cviolan@idiapjgol.org.
authors.forename: Concepción
authors.initials: C
authors.lastname: Violán
authors.forename: Oleguer
authors.initials: O
authors.lastname: Plana-Ripoll
authors.forename: Quintí
authors.initials: Q
authors.lastname: Foguet-Boreu
authors.forename: Bonaventura
authors.initials: B
authors.lastname: Bolíbar
authors.forename: Alba
authors.initials: A
authors.lastname: Aguado
authors.forename: Ruth
authors.initials: R
authors.lastname: Navarro-Artieda
authors.forename: Soledad
authors.initials: S
authors.lastname: Velasco-Velasco
authors.forename: Antoni
authors.initials: A
authors.lastname: Sicras-Mainar
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D003953:Diagnosis-Related Groups / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data*; D017598:Efficiency, Organizational / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D011320:Primary Health Care / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data*; D019984:Quality Indicators, Health Care / Q000191:economics / Q000706:statistics & numerical data; D011787:Quality of Health Care / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data; D013030:Spain; D016896:Treatment Outcome; D055815:Young Adult