University of Iowa, United States.
J Clin Anesth. 2017 Nov;42:63-68. doi: 10.1016/j.jclinane.2017.08.002. Epub 2017 Aug 18.
Anesthesiologists can provide psychometrically reliable daily evaluations of certified registered nurse anesthetist (CRNA) work habits for purposes of the mandatory ongoing professional practice evaluation (OPPE). Our goal was to evaluate the validity of assessing CRNA work habits.
Observational study.
Large teaching hospital.
N=77 anesthesiologists evaluated work habits of N=67 CRNAs. The non-technical attribute of work habits was measured on a 6-item scale (e.g., 1="Only assumed responsibility when forced to, and failed to follow through consistently" versus 5="Consistently identified tasks and completed them efficiently and thoroughly"). One year of scores were used to assess validity. Each daily evaluation could also be accompanied by a written comment. Content analysis of comments was performed using two years of data. Statistical analyses were performed using mixed effects logistic regression, treating each anesthesiologist as a fixed effect to compensate for the leniency of their ratings.
The N=77 anesthesiologists' response rate was 97.3%, obtained at a mean 2.93days after the request. The internal consistency of the scale was large: Cronbach's alpha 0.952. Controlling the false discovery rate at 5.0%, among the 67 CRNAs, 8 were significantly below average (each P≤0.0048) and 6 were above average (each P≤0.0018). During the 6months after CRNAs knew that their work habits scores would be used for OPPE, there were significant increases in the scores compared with the preceding 6months (odds ratio 1.93, P<0.0001). Greater CRNA's qualitative annual evaluation scores made by the chief CRNA, without knowledge of the work habit scores or comments, were associated with greater odds of the CRNA's leniency-adjusted work habit scores equaling 5.00 (odds ratio 1.53, P=0.0004). Comments of negative sentiment made by the anesthesiologists were associated with greater odds of the leniency-adjusted work habit scores being <5.00 (odds ratio 54.5, P<0.0001). Even though the anesthesiologists were already providing information about work habits using the work habits scale, approximately half the comments of negative sentiment included the theme of work habits (92/153, 60.1%).
Reporting OPPE metrics are mandatory for the maintenance of clinical privileges of anesthesia practitioners in the USA. Basing such peer review on work habits can be quantitative, psychometrically reliable, and valid.
麻醉师可以对认证注册护士麻醉师（CRNA）的工作习惯进行心理测量上可靠的日常评估，以进行强制性的持续专业实践评估（OPPE）。我们的目标是评估评估 CRNA 工作习惯的有效性。
观察性研究。
大型教学医院。
N=77 名麻醉师评估了 N=67 名 CRNA 的工作习惯。工作习惯的非技术属性是通过 6 项量表来衡量的（例如，1=“只有被迫时才承担责任，并且不能始终如一地坚持下去”，而 5=“始终明确任务并高效彻底地完成任务”）。使用一年的分数来评估有效性。每个日常评估还可以附有书面意见。使用两年的数据对意见进行内容分析。使用混合效应逻辑回归进行统计分析，将每个麻醉师视为固定效应，以补偿其评分的宽松性。
77 名麻醉师的回复率为 97.3%，在请求发出后的平均 2.93 天内获得。该量表的内部一致性很高：克朗巴赫的 alpha 为 0.952。控制假发现率为 5.0%，在 67 名 CRNA 中，有 8 名明显低于平均水平（每项 P≤0.0048），有 6 名高于平均水平（每项 P≤0.0018）。在 CRNA 知道其工作习惯得分将用于 OPPE 的 6 个月后，与前 6 个月相比，得分显著增加（优势比 1.93，P<0.0001）。首席 CRNA 对 CRNA 的定性年度评估得分越高，而无需了解工作习惯得分或意见，则与 CRNA 的宽松调整后工作习惯得分等于 5.00 的几率越大（优势比 1.53，P=0.0004）。麻醉师发表的负面情绪评论与宽松调整后的工作习惯评分<5.00 的几率更高（优势比 54.5，P<0.0001）有关。即使麻醉师已经使用工作习惯量表提供了有关工作习惯的信息，但大约一半的负面情绪评论都包含工作习惯主题（92/153，60.1%）。
报告 OPPE 指标是美国麻醉师临床执业许可维持的强制性要求。基于工作习惯的这种同行评审可以是定量的、心理测量可靠的和有效的。
