Burt Jenni, Abel Gary, Elmore Natasha, Campbell John, Roland Martin, Benson John, Silverman Jonathan
Cambridge Centre for Health Services Research, University of Cambridge, Cambridge, UK.
BMJ Open. 2014 Mar 6;4(3):e004339. doi: 10.1136/bmjopen-2013-004339.
To investigate initial reliability of the Global Consultation Rating Scale (GCRS: an instrument to assess the effectiveness of communication across an entire doctor-patient consultation, based on the Calgary-Cambridge guide to the medical interview), in simulated patient consultations.
Multiple ratings of simulated general practitioner (GP)-patient consultations by trained GP evaluators.
UK primary care.
21 GPs and six trained GP evaluators.
GCRS score.
6 GP raters used GCRS to rate randomly assigned video recordings of GP consultations with simulated patients. Each of the 42 consultations was rated separately by four raters. We considered whether a fixed difference between scores had the same meaning at all levels of performance. We then examined the reliability of GCRS using mixed linear regression models. We augmented our regression model to also examine whether there were systematic biases between the scores given by different raters and to look for possible order effects.
Assessing the communication quality of individual consultations, GCRS achieved a reliability of 0.73 (95% CI 0.44 to 0.79) for two raters, 0.80 (0.54 to 0.85) for three and 0.85 (0.61 to 0.88) for four. We found an average difference of 1.65 (on a 0-10 scale) in the scores given by the least and most generous raters: adjusting for this evaluator bias increased reliability to 0.78 (0.53 to 0.83) for two raters; 0.85 (0.63 to 0.88) for three and 0.88 (0.69 to 0.91) for four. There were considerable order effects, with later consultations (after 15-20 ratings) receiving, on average, scores more than one point higher on a 0-10 scale.
GCRS shows good reliability with three raters assessing each consultation. We are currently developing the scale further by assessing a large sample of real-world consultations.
在模拟医患咨询中，调查全球咨询评定量表（GCRS：一种基于卡尔加里 - 剑桥医学访谈指南，用于评估整个医患咨询过程中沟通效果的工具）的初始可靠性。
由经过培训的全科医生评估者对模拟全科医生（GP）-患者咨询进行多次评分。
英国初级医疗保健机构。
21名全科医生和6名经过培训的全科医生评估者。
GCRS评分。
6名全科医生评分者使用GCRS对与模拟患者进行的全科医生咨询的随机分配视频记录进行评分。42次咨询中的每一次都由4名评分者分别进行评分。我们考虑了分数之间的固定差异在所有表现水平上是否具有相同的含义。然后，我们使用混合线性回归模型检查GCRS的可靠性。我们扩展了回归模型，以检查不同评分者给出的分数之间是否存在系统偏差，并寻找可能的顺序效应。
在评估个体咨询的沟通质量时，对于两名评分者，GCRS的可靠性为0.73（95%置信区间0.44至0.79）；对于三名评分者为0.80（0.54至0.85）；对于四名评分者为0.85（0.61至0.88）。我们发现最宽松和最严格的评分者给出的分数平均相差1.65（0至10分制）：针对这种评估者偏差进行调整后，两名评分者的可靠性提高到0.78（0.53至0.83）；三名评分者为0.85（0.63至0.88）；四名评分者为0.88（0.69至0.91）。存在相当大的顺序效应，较晚的咨询（在15 - 20次评分之后）在0至10分制上平均得分高出一分以上。
由三名评分者评估每次咨询时，GCRS显示出良好的可靠性。我们目前正在通过评估大量实际咨询样本进一步完善该量表。
