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首页> 外文期刊>The Australian and New Zealand journal of psychiatry >Clinical indicators for routine use in the evaluation of early psychosis intervention: development, training support and inter-rater reliability.
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Clinical indicators for routine use in the evaluation of early psychosis intervention: development, training support and inter-rater reliability.

机译：在早期精神病干预评估中常规使用的临床指标：发展，培训支持和评估者间的信度。

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AIM: Clinical practice improvement carried out in a quality assurance framework relies on routinely collected data using clinical indicators. Herein we describe the development, minimum training requirements, and inter-rater agreement of indicators that were used in an Australian multi-site evaluation of the effectiveness of early psychosis (EP) teams. METHODS: Surveys of clinician opinion and face-to-face consensus-building meetings were used to select and conceptually define indicators. Operationalization of definitions was achieved by iterative refinement until clinicians could be quickly trained to code indicators reliably. Calculation of percentage agreement with expert consensus coding was based on ratings of paper-based clinical vignettes embedded in a 2-h clinician training package. RESULTS: Consensually agreed upon conceptual definitions for seven clinical indicators judged most relevant to evaluating EP teams were operationalized for ease-of-training. Brief training enabled typical clinicians to code indicators with acceptable percentage agreement (60% to 86%). For indicators of suicide risk, psychosocial function, and family functioning this level of agreement was only possible with less precise 'broad range' expert consensus scores. Estimated kappa values indicated fair to good inter-rater reliability (kappa > 0.65). Inspection of contingency tables (coding category by health service) and modal scores across services suggested consistent, unbiased coding across services. CONCLUSIONS: Clinicians are able to agree upon what information is essential to routinely evaluate clinical practice. Simple indicators of this information can be designed and coding rules can be reliably applied to written vignettes after brief training. The real world feasibility of the indicators remains to be tested in field trials.
机译：目的：在质量保证框架内进行的临床实践改进依赖于使用临床指标常规收集的数据。在这里，我们描述了在澳大利亚早期精神病（EP）团队有效性的多站点评估中使用的指标的发展，最低培训要求和评估者之间的共识。方法：使用临床医生意见调查和面对面的共识建立会议来选择指标并在概念上定义指标。定义的可操作性是通过反复完善来实现的，直到可以快速培训临床医生可靠地对指标进行编码。使用专家共识编码的百分比一致性的计算基于嵌入在2小时临床医生培训包中的纸质临床小插图的等级。结果：经协商一致同意，对被认为与评估EP小组最相关的七个临床指标的概念定义进行了培训，以简化培训。简短的培训使典型的临床医生能够编码可接受的百分比一致性（60％至86％）的指标。对于自杀风险，社会心理功能和家庭功能的指标，只有不太精确的“广泛范围”专家共识分数，才可以达到这一水平的协议。估计的kappa值表明评估者之间的可靠性相当好（kappa> 0.65）。检查应急表（按卫生服务分类的编码类别）和跨服务的模态分数，表明跨服务的编码一致，无偏见。结论：临床医生能够就常规评估临床实践必不可少的信息达成共识。经过简短的培训后，可以设计该信息的简单指示符，并且可以将编码规则可靠地应用于书面的小插图。这些指标在现实世界中的可行性仍有待在现场试验中进行测试。

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