Severity-of-illness measurement is considered to be an important factor in the risk adjustment of medical outcomes. However, for those measures that involve a high level of clinical judgment, strategies have to be developed to maximize the consistency of rating severity that can be implemented, especially when rating is based upon medical record review. A group of 25 clinicians were sent the same set of 14 patient records, and requested to use the Duke University Severity of Illness (DUSOI) checklist to rate the severity of patients' illness. Written instructions for the use of this instrument were provided. A short educational intervention was than made by the research team, and the clinicians were sent the same set of records to be rated again. Any improvement in the accuracy and reliability of severity assessment over the two ratings was then studied. The educational intervention resulted in identification of fewer irrelevant health problems. However, it had little impact upon the reliability of severity scoring itself, as measured by the intraclass correlation coefficient. Measuring severity of illness is a conceptually complex procedure. However, given its role in outcome interpretation, it may be worth pursuing strategies aimed at maximizing consistency of clinician rating. There are a number of options, including improved written instructions and more intensive training, that could be implemented.
Background Involving carers is a key priority in mental health services. Carers report the sharing of service users’ safety information by mental health nurses is problematic and seldom takes place. Aims The impact of an intervention on consensus between nurses and carers on perceptions of risk was investigated. Methods Carer–nurse risk consensus scores were measured pre- and post-introduction of a structured dialogue (paired t-test/ANOVA). Carer experience with involvement was surveyed pre-test ( n = 60) and compared with the post-test intervention group ( n = 32) (chi-square tests of linear-by-linear association). Results Consensus and perceptions regarding type and severity of risk did not change significantly for carers or nurses after engaging in a structured dialogue. Statistically significant differences were found with carers reporting higher levels of satisfaction with services in four out of six areas surveyed. Conclusions Findings provide support for increasing carer contribution to discussions regarding risk. Further work to embed carer involvement in clinical practice is warranted.
Effective parental management of childhood eczema requires education and support to reduce disease severity and improve the child's quality of life. Self-efficacy is a key factor influencing effective chronic disease management, yet there are no published scales to measure parental self-efficacy in managing childhood eczema. The Parental Self-Efficacy with Eczema Care Index (PASECI) was designed to measure parental self-efficacy in managing childhood eczema as a pre- and postintervention tool in the evaluation of a structured Eczema Education Programme (EEP).To develop and test the validity, reliability and sensitivity of a new outcome measure (PASECI) designed to assess parental self-efficacy in managing their child's eczema to determine pre- vs. postintervention changes in educational intervention evaluation studies.PASECI was developed from the literature, expert consultation and piloting of a 40-item prototype. The final 29-item scale is arranged in four subscales. Parents of children with eczema aged 0-16 years (n = 242) attending the EEP were assessed at 1 week pre-EEP and 4 weeks postintervention. Cronbach's α and factor analyses were undertaken.PASECI has face, content and construct validity. It is reliable, with high item internal consistency (α > 0·87 in all domains). Factor analysis revealed four viable domains. It was sensitive to change for postintervention measures using sign tests (P < 0·001).PASECI is a useful, valid, reliable and sensitive evaluative outcome measure of self-efficacy in parents managing childhood eczema.
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