Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America.
American Heart Association, Kweneng, Botswana.
PLoS One. 2019 Aug 2;14(8):e0220565. doi: 10.1371/journal.pone.0220565. eCollection 2019.
Serious childhood illnesses (SCI), defined as severe pneumonia, severe dehydration, sepsis, and severe malaria, remain major contributors to amenable child mortality worldwide. Inadequate recognition and treatment of SCI are factors that impact child mortality in Botswana. Skills assessments of providers caring for SCI have not been validated in low and middle-income countries.
To establish preliminary inter-rater reliability, validity evidence, and feasibility for an assessment of providers who care for SCI using simulated patients and remote video capture in community clinic settings in Botswana.
This was a pilot study. Four scenarios were developed via a modified Delphi technique and implemented at primary care clinics in Kweneng, Botswana. Sessions were video captured and independently reviewed. Response process and internal structure analysis utilized intra-class correlation (ICC) and Fleiss' Kappa. A structured log was utilized for feasibility of remote video capture.
Eleven subjects participated. Scenarios of Lower Airway Obstruction (ICC = 0.925, 95%CI 0.695-0.998) and Hypovolemic Shock from Severe Dehydration (ICC = 0.892, 95%CI 0.596-0.997) produced excellent ICC among raters while Lower Respiratory Tract Infection (LRTI, ICC = 0, 95%CI -0.034-0.97) and LRTI + Distributive Shock from Sepsis (0.365, 95%CI -0.025-0.967) were poor. Oxygen therapy (0.707), arranging transport (0.706), and fluid administration (0.701) demonstrated substantial task reliability.
Initial development of an assessment tool demonstrates many, but not all, criteria for validity evidence. Some scenarios and tasks demonstrate excellent reliability among raters, but others may be limited by manikin design and study implementation. Remote simulation assessment of some skills by clinic-based providers in global health settings is reliable and feasible.
严重儿童疾病（SCI），定义为严重肺炎、严重脱水、败血症和严重疟疾，仍然是全球可预防儿童死亡的主要原因。在博茨瓦纳，对 SCI 的认识不足和治疗不当是影响儿童死亡率的因素。对治疗 SCI 的提供者的技能评估在中低收入国家尚未得到验证。
在博茨瓦纳社区诊所的模拟患者和远程视频捕获中，建立对治疗 SCI 的提供者进行评估的初步评分者间可靠性、有效性证据和可行性。
这是一项试点研究。通过改良 Delphi 技术制定了四个方案，并在博茨瓦纳的初级保健诊所实施。会议进行了视频拍摄并进行了独立审查。反应过程和内部结构分析采用了组内相关系数（ICC）和 Fleiss Kappa。结构化日志用于远程视频捕获的可行性。
11 名受试者参与了研究。下呼吸道阻塞（ICC=0.925，95%CI 0.695-0.998）和严重脱水引起的低血容量性休克（ICC=0.892，95%CI 0.596-0.997）的方案产生了评分者间极好的 ICC，而下呼吸道感染（LRTI，ICC=0，95%CI-0.034-0.97）和 LRTI+败血症引起的分布性休克（0.365，95%CI-0.025-0.967）的 ICC 较差。氧气治疗（0.707）、安排转运（0.706）和液体管理（0.701）显示出了较高的任务可靠性。
评估工具的初步开发展示了许多但不是全部有效性证据标准。一些方案和任务在评分者之间表现出了极好的可靠性，但其他方案可能受到模拟人设计和研究实施的限制。在全球卫生环境中，对诊所基础提供者的某些技能进行远程模拟评估是可靠和可行的。
