Authors
Walsh, Kathleen E.Harik, Polina
Mazor, Kathleen M.
Perfetto, Deborah
Anatchkova, Milena D.
Biggins, Colleen
Wagner, Joann
Schoettker, Pamela J.
Firneno, Cassandra
Klugman, Robert
Tjia, Jennifer
UMass Chan Affiliations
Department of Quantitative Health SciencesDocument Type
Journal ArticlePublication Date
2017-04-01Keywords
patient safetygeneralizability theory
healthcare associated harm
Health Services Administration
Health Services Research
Metadata
Show full item recordAbstract
OBJECTIVE: The objective of this study was to identify modifiable factors that improve the reliability of ratings of severity of health care-associated harm in clinical practice improvement and research. METHODS: A diverse group of clinicians rated 8 types of adverse events: blood product, device or medical/surgical supply, fall, health care-associated infection, medication, perinatal, pressure ulcer, surgery. We used a generalizability theory framework to estimate the impact of number of raters, rater experience, and rater provider type on reliability. RESULTS: Pharmacists were slightly more precise and consistent in their ratings than either physicians or nurses. For example, to achieve high reliability of 0.83, 3 physicians could be replaced by 2 pharmacists without loss in precision of measurement. If only 1 rater was available for rating, approximately 5% of the reviews for severe harm would have been incorrectly categorized. Reliability was greatly improved with 2 reviewers. CONCLUSIONS: We identified factors that influence the reliability of clinician reviews of health care-associated harm. Our novel use of generalizability analyses improved our understanding of how differences affect reliability. This approach was useful in optimizing resource utilization when selecting raters to assess harm and may have similar applications in other settings in health care.Source
Med Care. 2017 Apr;55(4):436-441. doi: 10.1097/MLR.0000000000000679. Link to article on publisher's site
DOI
10.1097/MLR.0000000000000679Permanent Link to this Item
http://hdl.handle.net/20.500.14038/29120PubMed ID
27906769Related Resources
ae974a485f413a2113503eed53cd6c53
10.1097/MLR.0000000000000679