Measuring the Necessity of Medical Procedures

Kahan, James P.; Bernstein, Steven J.; Leape, Lucian L.; Hilborne, Lee H.; Park, Rolla Edward; Parker, Lori; Kamberg, Caren; Brook, Robert H.

doi:10.1097/00005650-199404000-00004

Cited by 127 publications

(68 citation statements)

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“…5 The ease of applying this technique using a computer-based program has shifted focus from the traditional pen and pencil to electronically generated Delphi responses.…”

Section: Discussionmentioning

confidence: 99%

Simulation performance checklist generation using the Delphi technique

Morgan

Lam-McCulloch

Herold-McIlroy

et al. 2007

Can J Anesth/J Can Anesth

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Purpose: Performance assessment using high fidelity simulation is problematic, due to the difficulty in developing valid and reliable evaluation tools. The Delphi technique is a consensus based content generation method used for multiple purposes such as policy development, best-evidence practice guidelines and competency assessments. The purpose of this study was to develop checklists using a modified Delphi technique to evaluate the performance of practicing anesthesiologists managing two simulated scenarios. Methods:The templates for two simulation scenarios were emailed to five anesthesiologists who were asked to generate performance items. Data were collated anonymously and returned. An a priori decision was made to delete items endorsed by ≤ 20% of participants. This process of collection, collation and re-evaluation was repeated until consensus was reached. Four independent raters used the checklist to assess three subjects managing the two simulation scenarios. Interrater reliability was assessed using average measures intraclass correlation (ICC) and repeated measures analysis of variance (ANOVA) was used to assess differences in difficulty between scenarios. Results:The final checklists included 131 items for scenario 1 and 126 items for scenario 2. The mean inter-rater reliability was 0.921 for scenario 1 and 0.903 for scenario 2. Repeated measures ANOVA revealed no statistically significant difference in difficulty between scenarios.Discussion: The Delphi technique can be very useful to generate consensus based evaluation tools with high content and face validity compared to subjective evaluative tools. Since there was no difference in scenario difficulty, these scenarios can be used to determine the effect of educational interventions on performance.

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“…5 The ease of applying this technique using a computer-based program has shifted focus from the traditional pen and pencil to electronically generated Delphi responses.…”

Section: Discussionmentioning

confidence: 99%

Simulation performance checklist generation using the Delphi technique

Morgan

Lam-McCulloch

Herold-McIlroy

et al. 2007

Can J Anesth/J Can Anesth

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“…Brook and colleagues introduced the construct of appropriateness and necessity of care, based on the relative balance of risk, benefits, and importance. [76][77][78][79][80] The recent field of patient safety has emerged to focus on the technical quality of care, specifically related to medical errors. 23,81,82 The failure to deliver a planned or necessary service represents another type of medical error, as does failure to notify or provide appropriate follow-up, as might occur after an abnormal cervical cancer screen is victimized by a medical error.…”

Section: Current Theorymentioning

confidence: 99%

Assessing Quality Improvement in Health Care: Theory for Practice

Kleinman

Dougherty

2013

Pediatrics

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To review the role of theory as a means to enhance the practice of quality improvement (QI) research and to propose a novel conceptual model focused on the operations of health care. METHODS:Conceptual model, informed by literature review. RESULTS:To optimize learning across QI studies requires the integration of small-scale theories (middle-range theories, theories of change) within the context of larger unifying theories. We propose that health care QI research would benefit from a theory that describes the operations of health care delivery, including the multiplicity of roles that interpersonal interactions play. The broadest constructs of the model are entry into the system, and assessment and management of the patient, with the subordinate operations of access; recognition, assessment, and diagnosis; and medical decision-making (developing a plan), coordination of care, execution of care, referral and reassessment, respectively. Interpersonal aspects of care recognize the patient/ caregiver as a source of information, an individual in a cultural context, a complex human being, and a partner in their care. Impacts to any and all of these roles may impact the quality of care.CONCLUSIONS: Such a theory can promote opportunities for moving the field forward and organizing the planning and interpretation of comparable studies. The articulation of such a theory may simultaneously provide guidance for the QI researcher and an opportunity for refinement and improvement. Pediatrics 2013;131:S110-S119

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“…By this I mean a level of care that meets the following criteria: The benefits to the patient exceed the risks; providers believe that it would be improper not to recommend this care and would go on strike if they could not provide such care; there is more than a reasonable chance that the care will benefit the patient; and the benefit to the patient is not small. 2 Provision of this care should be strongly advocated by the medical profession and be supported by scientific data. We should be able to measure whether this level of care has been provided and report our success or failure to the appropriate governmental and public agencies, including Congress and the president.…”

Section: Goals Of Health Care For the Elderlymentioning

confidence: 99%