Validating the Emergency Department Avoidability Classification (EDAC): A cluster randomized single-blinded agreement study

• DOI: 10.1371/journal.pone.0297689
• Publication Date: 2024-01-23T18:28:02Z
• Authors: Ryan P. Strum; Shawn Mondoux; Fabrice I. Mowbray; Lauren E. Griffith; Andrew Worster; Walter Tavares; Paul Miller; Komal Aryal; Ravi Sivakumaran; Andrew P. Costa
• Keywords: Inter-Rater Reliability; Kappa; Concordance; Cohen's kappa

Introduction The Emergency Department Avoidability Classification (EDAC) retrospectively classifies emergency department (ED) visits that could have been safely managed in subacute primary care settings, but has not validated against a criterion standard. A EDAC enable accurate and reliable quantification of avoidable ED visits. We compared agreement between the physician judgements to specify Materials methods conducted cluster randomized, single-blinded study an academic hospital Hamilton, Canada. January 1, 2019, December 31, 2019 were clustered based on classes randomly sampled evenly. total 160 visit charts assigned ten participating physicians at for evaluation. Physicians judged if appropriately (an visit); each was evaluated by two independently. measured interrater with Cohen’s kappa 95% confidence intervals (CI). correlation using Spearman rank ordinal logistic regression odds ratios (ORs) CIs. examined EDAC’s precision identify accuracy, sensitivity specificity. Results agreed 139 (86.9%) 0.69 (95% CI 0.59–0.79), indicating substantial agreement. 96.2% classified as suitable management care. found high (0.64), well very strong association classify (OR 80.0, 17.1–374.9). EDACs potentially demonstrated accuracy (82.8%, 78.2–86.8). Discussion evidence validity This classification important potential accurately monitoring trends utilization, measuring proportions volume attributed informing interventions intended reducing use patients who do require or life-saving healthcare.