Kernaghan D, Penney G C
Scottish Programme for Clinical Effectiveness in Reproductive Health, Department of Obstetrics and Gynaecology, Simpson Centre for Reproductive Health, Edinburgh, UK.
Qual Saf Health Care. 2006 Oct;15(5):359-62. doi: 10.1136/qshc.2006.018572.
A national audit project, Scotland-wide Learning from Intrapartum Critical Events (SLICE), included local assessment of quality of care in cases of perinatal death and neonatal encephalopathy due to intrapartum events. Concerns had been raised about interobserver variation in case assessment by different panels. We therefore studied the extent of agreement and disagreement between assessment panels, and examined the areas in which agreement and disagreement tended to occur.
8 cases were randomly selected from all 42 cases identified during a 6-month period (1 January-1 July 2005). Each case was independently reviewed by three panels: the local hospital clinical risk-management group and two specially convened external panels. Panels assessed quality of care in three areas: admission assessment, recognition of incident, and method and timing of delivery. Predefined standards of care were provided for these three areas. Panels were also asked to assess the overall quality of care.
For each area of care, agreement between the two external panels was lowest. The lowest levels of agreement between panels were seen in assessment of overall care (50% crude agreement between external panel 1 and the hospital (kappa = 0.24, AC(1) = 0.36); 29% crude agreement between external panels 1 and 2 (kappa = -0.11, AC(1) = 0.1); 47% crude agreement between external panel 2 and the hospital (kappa = 0.36, AC(1) = 0.46). The lowest level of agreement among all three panels was also in the assessment of overall care (crude agreement 48%; kappa = 0.16, AC(1) = 0.34).
Moderate to substantial agreement among the three panels was achieved for the three areas in which explicit standards were provided. Therefore, a systematic approach to analysis of adverse events in perinatal care improves reproducibility.
一项全苏格兰范围内的国家审计项目——“从产时危急事件中学习”（SLICE），包括对围产期死亡和因产时事件导致的新生儿脑病病例的当地护理质量评估。不同小组在病例评估中的观察者间差异引发了关注。因此，我们研究了评估小组之间的一致和不一致程度，并检查了一致和不一致倾向于出现的领域。
从2005年1月1日至7月1日这6个月期间确定的所有42例病例中随机选取8例。每个病例由三个小组独立审查：当地医院临床风险管理小组和两个特别召集的外部小组。小组在三个领域评估护理质量：入院评估、事件识别以及分娩方法和时机。为这三个领域提供了预先定义的护理标准。小组还被要求评估整体护理质量。
对于每个护理领域，两个外部小组之间的一致性最低。在整体护理评估中，小组之间的一致性水平最低（外部小组1与医院之间的粗略一致性为50%（kappa = 0.24，AC(1) = 0.36）；外部小组1与2之间的粗略一致性为29%（kappa = -0.11，AC(1) = 0.1）；外部小组2与医院之间的粗略一致性为47%（kappa = 0.36，AC(1) = 0.46）。所有三个小组之间最低的一致性水平也在整体护理评估中（粗略一致性为48%；kappa = 0.16，AC(1) = 0.34）。
对于提供了明确标准的三个领域，三个小组之间达成了中度到高度的一致性。因此，一种系统的围产期护理不良事件分析方法提高了可重复性。
