Submited on: 01 Mar 2011 11:50:21 AM GMT
Published on: 01 Mar 2011 09:41:49 PM GMT
 
Research protocol review
Posted by Dr. Antoni Arias on 02 Jun 2011 08:00:04 AM GMT

1 Is the subject of the article within the scope of the subject category? Yes
2 Are the interpretations / conclusions sound and justified by the data? Partly
3 Is this a new and original contribution? No
4 Does this paper exemplify an awareness of other research on the topic? Yes
5 Are structure and length satisfactory? No
6 Can you suggest brief additions or amendments or an introductory statement that will increase the value of this paper for an international audience? Yes
7 Can you suggest any reductions in the paper, or deletions of parts? Yes
8 Is the quality of the diction satisfactory? No
9 Are the illustrations and tables necessary and acceptable? No
10 Are the references adequate and are they all necessary? No
11 Are the keywords and abstract or summary informative? Yes
  • Other Comments:

    Since it is a research protocol, I don't expect conclusions at this stage. I cannot evaluate the length of the paper, tables and illustrations.

    The Design and Methods section probably can be reduced and focused on the paper issue.

    MAJOR ISSUES:

    1) It is not clear what does it mean "adaptation capacitating of categories ACG": The objective of the study must be clarified.

    2) Once it is clarified, the authors must also clarify how they will evaluate the "adaptation". From the research protocol, it is not clear wich measures they use.

    3) Design and Methods, Main measures:

    - Implicitly the authors describe a model: What do they try to do through this model?;

    - They define as dependent variable one that is tipically independent: care episodes.

    - Total costs are considered dependent as well as "additional" (independent?) variable: it is not consistent.

    4) Design and Methods, The ACG Risk Adjustment System:

    - Charlson Index is cited as a proxy to patient severity, but it is not included in the statistical analysis proposal

    5) Design and Methods, statistical analysis:

    - The authors propose three models of linear regression; in the third one they use "number of episodes" as independent variable: Does episodes mean diagnostics?; why they don't use ACG group as independent variable?

     

    MINOR ISSUES:

    1) English must be improve (e.g. "realized" means really "developed"; it is a direct translation of Spanish and does not mean the same in English).

    2)The paper needs further revision of formal contents: There is a duplicated paragraph in the Discussion section.

     

  • Competing interests:
    I'm working in a company that distributes ACG software, but no competing interest do exist.
  • Invited by the author to review this article? :
    Yes
  • Have you previously published on this or a similar topic?:
    No
  • References:
    None
  • Experience and credentials in the specific area of science:

    Use of casemix systems in healthcare

  • How to cite:  Arias A .Research protocol review[Review of the article 'Adaptation of the Categories Johns-Hopkins ACG Case-Mix System in Primary Healthcare: a Longitudinal, Retrospective Claim Database Study. ' by Violan-Fors C].WebmedCentral 2011;2(6):WMCRW00795
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Review of WebmedCentral Article
Posted by Dr. Karen Kinder on 18 May 2011 09:27:12 AM GMT

  • Other Comments:

    MAJOR ISSUES
    1.The article is missing Results or a Conclusion. It reads as a project proposal and not a completed research study. It would be advantageous to present the results or wait until the study has been completed before publishing. In this regard, the “Study timeline” is not needed.
    2.There is confusion raised by the use of the word “episodes”.
    a.Under “Main measures” “care episodes” are listed as a dependent variable. These are “quantified according to the International Classification of Primary Health”. This creates an endogenous model when at the same time, one of the independent variables “b) case-mix or co-morbidity” which is defined as “b) the individual case-mix index, obtained by the ACG.”
    b.Under “Statistical Analysis” the third model of linear regression is described as using “age, sex and number of episodes” as the independent variable. If “number of episodes” is to be a measure of morbidity then it is not a number, nor is it episodic.
    3.The authors talk about “Adaptation” (under “Discussion”) yet there is no explanation of what adaptations were undertaken.
    4.The authors incorrectly describe the ACG System in the “Background”. The ACG System does not classify “individuals according to the diseases that they present” but by the patients’ diagnoses.
    5.Similarly, the ACG System’s major objective is not “to measure the degree of disease”, but “to measure the degree of morbidity.”
    6.The authors need to acknowledge that the use of the ICPC Coding System is not legally licensed in Spain.
    MINOR ISSUES
    7.The title has several errors.
    a.“Johns Hopkins” does not contain a hyphen.
    b.The ACG System is not the “ACG Case-Mix System”. And a copyright symbol needs to be attached the first time it occurs in the manuscript.
    c.“Categories” should be deleted from the title.
    8.The article needs to be edited by a native English speaker. Several sentences are unclear.
    9.Under “Design and study setting” the text is written in both future (i.e. “will be”) and past (i.e. “consisted”) tense.
    10.“The ACG Risk Adjustment System” contains the following issues:
    a.“ICD-9-MC” should be “ICD-9-CM” since the article is written in English.
    b.“This method provides the United States of each group with respect….” makes no sense.
    c.The sentence mentioning the Expanded Diagnosis Clusters should be deleted since the EDCs have nothing to do with this study.
    11.Under “Models of cost….” The authors refer to “semi-fixed costs” in their formula for cost per patient, yet these are never defined.
    12.Also, the formula for cut-off point (T) is incorrect
    13.Under “Discussion” the first sentence is repeated in the second paragraph.

  • Invited by the author to review this article? :
    Yes
  • Have you previously published on this or a similar topic?:
    No
  • References:
    None
  • Experience and credentials in the specific area of science:
    None
  • How to cite:  Kinder K .Review of WebmedCentral Article[Review of the article 'Adaptation of the Categories Johns-Hopkins ACG Case-Mix System in Primary Healthcare: a Longitudinal, Retrospective Claim Database Study. ' by Violan-Fors C].WebmedCentral 2011;2(5):WMCRW00759
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