La Trobe University, Faculty of Health Sciences, Melbourne, Australia.
Clin Rehabil. 2011 Jul;25(7):599-606. doi: 10.1177/0269215510389344. Epub 2011 Mar 7.
To evaluate the effect of formal training on agreement between clinicians making decisions on client priority.
A centralized intake service receiving referrals for a community rehabilitation programme.
Agreement was measured between the priority categories allocated to consecutive referrals by one of five clinicians in the referral office compared with a second rating made by an independent occupational therapist, blinded to the initial priority rating. Data collection followed the implementation of four 1-hour workshops involving all raters, designed to increase consistency of triage decisions. Results were compared to a previous study conducted prior to the training.
Two hundred and one consecutive referrals received for community rehabilitation services, triaged by experienced clinicians with allied health or nursing qualifications.
Agreement using weighted kappa (κ(w)).
There was no change in agreement between clinicians after training, compared with a previous study in the same setting. Agreement remained moderate (κ(w) = 0.50), with clinicians disagreeing on approximately 30% of referrals.
Three out of 10 clients will receive a different priority rating and waiting time for rehabilitation services depending on which clinician in the referral office made the rating. This result was not improved by conducting a training programme.
评估正式培训对临床医生在客户优先级决策上达成一致的影响。
集中受理服务接收社区康复计划的转介。
通过比较转诊办公室的五位临床医生中的一位对连续转介分配的优先级类别，与独立的职业治疗师进行的第二次评估，评估优先级分配的一致性。该评估是在涉及所有评估者的四个 1 小时工作坊实施后进行的，旨在提高分诊决策的一致性。结果与培训前进行的先前研究进行了比较。
接受社区康复服务的 201 例连续转介，由具有联合健康或护理资格的经验丰富的临床医生进行分诊。
使用加权 κ（κ（w））进行一致性评估。
与同一环境下的先前研究相比，培训后临床医生之间的一致性没有变化。一致性仍然处于中等水平（κ（w）= 0.50），大约 30%的转介存在分歧。
取决于转诊办公室的哪位临床医生进行了评估，10 个客户中有 3 个将获得不同的优先级和康复服务等待时间。通过进行培训计划，并没有改善这种情况。
