Kliebsch U, Brenner H
Abteilung Epidemiologie, Universität Ulm.
Gesundheitswesen. 1995 Oct;57(10):638-44.
In this paper, we present the first study on the inter-rater reliability of a standardised examination of functional disability, employed by the medical service of the German statutory health insurance system ("Medizinischer Dienst der Krankenversicherung", MDK). 215 elderly adults (mean age 84) living in 6 nursing homes in Munich were included in the study. They were assessed by three medical students and two nurses of the respective nursing homes using the standardised questionnaire of the MDK. Inter-rater reliability of both a summary judgement of disability and of single items, such as impairments in activities of daily living, was assessed by kappa-coefficients. Inter-rater reliability was higher for the overall assessment of disability (kappa = 0.82 between nurses, kappa = 0.57 between medical students) than for most single items. Reliability was particularly low for some items on mental status (such as "restlessness") or perceptions (particularly visual perception) which require clearer definition. This pattern was consistently observed for the two types of comparisons (inter-students, nurse-nurse) and for different subgroups of the study population.
在本文中，我们首次对德国法定医疗保险系统的医疗服务机构（“医疗保险医疗服务机构”，MDK）所采用的功能残疾标准化检查的评分者间信度进行了研究。研究纳入了慕尼黑6家养老院的215名老年人（平均年龄84岁）。由各自养老院的3名医科学生和2名护士使用MDK的标准化问卷对他们进行评估。通过kappa系数评估残疾总体判断以及诸如日常生活活动受损等单个项目的评分者间信度。残疾总体评估的评分者间信度（护士之间kappa = 0.82，医科学生之间kappa = 0.57）高于大多数单个项目。对于一些精神状态项目（如“坐立不安”）或感知项目（特别是视觉感知），由于需要更清晰的定义，其信度特别低。在两种比较类型（学生间、护士间）以及研究人群的不同亚组中均一致观察到这种模式。
