Jobanputra P, Arthur V, Pugh M, Spannuth F, Griffiths P, Thomas E, Sheeran T
Department of Rheumatology, University Hospital Birmingham Foundation Trust, Selly Oak Hospital, Raddlebarn Road, Selly Oak, Birmingham B29 6JD, UK.
Rheumatology (Oxford). 2005 May;44(5):633-7. doi: 10.1093/rheumatology/keh566. Epub 2005 Mar 1.
Assessments of NSAID use based on authoritative guidelines typically overlook patients' views and nuances of medical history. Our objective was to develop an assessment tool that incorporates these aspects, and technical items, for quality of care assessments in NSAID users.
Patients newly referred to a university hospital were interviewed by a nurse using an agreed template. A multidisciplinary group of rheumatologists, nurse specialists, primary care physicians and a pharmacist reviewed current guidance and systematic reviews on NSAID use, and a series of interview transcripts. The group agreed, by informal consensus, important determinants of effective and safe NSAID use. Technical aspects of medical care and items that reflected interpersonal care were included in an index for assessing quality of care for individual patients. Interview transcripts of 100 patients were scored by panel members and reliability of scores was tested by calculating weighted percentage agreement and the kappa statistic.
Our final index had five domains: medical risk factors; steps taken to reduce risk; knowledge of adverse effects; NSAID dose; and cost efficiency. Each item was scored 0, 1 or 2. Scores were summed, giving a maximum of 10 (low scores indicating low quality). Intra-rater agreement was >90%; kappa was 0.47-0.87 for individual domains and 0.59 for overall score. Inter-rater agreement for overall score was 95%; kappa was 0.25-0.78 for domains and 0.48 for overall score. Patients with especially low scores were identified using the mode of scores for five assessors; obvious clinical concerns were identified, supporting index face validity.
A simple index to evaluate quality of care for NSAID users based on a patient interview is described. This may be used by one or more assessors to examine care standards and highlight deficiencies in relation to NSAID use in practice.
基于权威指南对非甾体抗炎药（NSAID）使用情况的评估通常会忽略患者的观点和病史细节。我们的目标是开发一种评估工具，该工具纳入这些方面以及技术项目，用于评估NSAID使用者的医疗质量。
新转诊至大学医院的患者由护士使用商定的模板进行访谈。一组由风湿病学家、护士专家、初级保健医生和药剂师组成的多学科团队回顾了关于NSAID使用的现行指南和系统评价，以及一系列访谈记录。该团队通过非正式共识确定了有效且安全使用NSAID的重要决定因素。医疗护理的技术方面以及反映人际护理的项目被纳入一个指数，用于评估个体患者的医疗质量。100名患者的访谈记录由小组成员评分，并通过计算加权百分比一致性和kappa统计量来测试评分的可靠性。
我们的最终指数有五个领域：医疗风险因素；降低风险采取的措施；不良反应知识；NSAID剂量；以及成本效益。每个项目的评分为0、1或2。分数相加，最高为10分（低分表示质量低）。评分者内一致性>90%；各领域的kappa值为0.47 - 0.87，总体评分的kappa值为0.59。总体评分的评分者间一致性为95%；各领域的kappa值为0.
