The applicability of methods for assessing comorbidities: The Cumulative Illness Rating Scale (CIRS)

This is the authors' abstract. We don't add key points for this paper.

Introduction It is essential to compare the results of medical care in patients suffering from multiple, and complex diseases. CIRS is a risk adjustment tool useful for assessing patients’ comorbidities although it needs to be used with precision following guidelines. The aim of this research is to assess whether organised seminars, planned to motivate the clinicians for correct data compilation, have an effect on the concordance of scores on the CIRS scores. Methods A prospective, pilot study started in November 2018 on a sample of 49 patients admitted to a private clinic between December 2018 and February 2019. In the context of a seminar, an Resident Physician in Public Health (RP), distributed and explained the CIRS guidelines to the clinicians. CIRS scores were then calculated by the ward physicians and compared with those of the RP who successively analysed the same medical records. The inter-rater agreement was calculated through Cohen’s kappa coefficient (κ), using Stata 14.2. Results Concordance was excellent or almost perfect or substantial for 8 out of 14 categories: heart disease (k = 0.82), genitourinary disease (k = 0.90) blood pressure category (p = 0.72), sense organs (k = 0.75), upper gastrointestinal system (k = 0.70), lower gastrointestinal system (k = 0.76), musculoskeletal system and skin (k = 0.66), central nervous system (k = 0.69), endocrine system and breast (k = 0.63) and psychiatric diseases (k = 0.63). The agreement was moderate for the respiratory system (k = 0.48) and for the liver (k = 0.57), and was fair for Severity Index, Comorbidity Index and the vascular system (k = 0.24, k = 0.38 and k = 0.28 respectively).No Concordance in renal diseases (k = 0.00). Conclusions Overall, the agreement of the scores between RP and clinicians was good, and it was possible to analyse the main weaknesses and difficulties of the clinicians. Subsequent seminars will be done to increase over time the concordance of the surveys. Key messages Organized seminars, planned to motivate clinicians to correctly compile the CIRS scores, were effective. The inter-rater agreement was good. Subsequent seminars will be done to increase over time the concordance of the surveys.