Chesser Amy, Reyes Jared, Woods Nikki Keene, Williams Kim, Kraft Robert
Department of Family and Community Medicine, University of Kansas School of Medicine-Wichita, Wichita, KS 67214-3199, USA.
Fam Med. 2013 Jun;45(6):428-32.
Patient-centered communication is an important component of primary care and related to improved patient health outcomes and satisfaction. The Patient-Centered Observation Form (PCOF) was developed as an educational assessment tool to improve resident physician-patient communication. However, reliability of the tool has not been tested.
Residents and patients were observed in routine medical encounters in a Midwestern family medicine residency center as part of a prospective, quasi-experimental study. Four independent observers (two faculty clinicians and two social scientists) used the PCOF to rate videorecorded patient encounters in the areas of establishing rapport, maintaining relationships, agenda setting, efficiency, information gathering, assessing patient perspectives, effective and open use of the electronic medical record (EMR), sharing information, discussion of behavior changes, co-creating a plan, and shared decision making.
A total of 13 physician-patient encounters were observed. Mean overall reliability for the PCOF was 0.67 using four raters, 0.45 for clinicians only, and 0.62 for social scientists. Adequate reliability (>0.7) was found for behavior change discussion (0.89) in clinician ratings but not with social scientists (0.62). Social scientists had adequate reliability in assessing patients' perspectives on health (0.86) and shared decision making (0.78), but these were not considered reliable among clinicians (0.46 and 0.00, respectively).
Reliability of the PCOF for assessing patient-centered competence is dependent on the content of communication being scored and the training history of the evaluator. These results challenge researchers and physicians to develop more reliable scoring instructions and tools for assessing patient-centered competence.
以患者为中心的沟通是初级医疗的重要组成部分，与改善患者健康结局及满意度相关。患者中心观察表（PCOF）作为一种教育评估工具而开发，用于改善住院医师与患者之间的沟通。然而，该工具的可靠性尚未得到测试。
作为一项前瞻性、准实验研究的一部分，在中西部一家家庭医学住院医师培训中心的常规医疗问诊中观察住院医师和患者。四名独立观察者（两名临床教员和两名社会科学家）使用PCOF对视频记录的患者问诊在建立融洽关系、维持关系、议程设定、效率、信息收集、评估患者观点、有效及开放使用电子病历（EMR）、信息共享、行为改变讨论、共同制定计划和共同决策等方面进行评分。
共观察了13次医患问诊。使用四名评分者时，PCOF的总体平均可靠性为0.67，仅临床医生评分时为0.45，社会科学家评分时为0.62。临床医生在行为改变讨论（0.89）评分中发现具有足够的可靠性（>0.7），但社会科学家的评分则不然（0.62）。社会科学家在评估患者对健康的观点（0.86）和共同决策（0.78）方面具有足够的可靠性，但在临床医生中这些评分被认为不可靠（分别为0.46和0.00）。
PCOF评估以患者为中心能力的可靠性取决于所评分的沟通内容以及评估者的培训经历。这些结果促使研究人员和医生开发更可靠的评分指南和工具来评估以患者为中心的能力。
