Bickman L, Karver M S, Schut L J
Nashville, Tennessee 37212, USA.
J Consult Clin Psychol. 1997 Jun;65(3):515-20. doi: 10.1037//0022-006x.65.3.515.
Accurately assigning children to the most appropriate level of care is widely recognized as important. Managed care companies conduct utilization reviews in which they monitor the level of care to which clients are assigned using written placement criteria. However, no research has examined the ability of clinicians to perform this task. In the present study, 47 child and adolescent clinical profiles consisting of 48 variables were developed. Eighteen clinicians, trained to use their agency's level-of-care guidelines, made level-of-care decisions on these profiles. Their interjudge reliability in assigning a child to an appropriate level of care was close to zero (kappa = .07). There was a small, statistically significant correlation between client placement and actual placement, but chance-corrected agreement between client placement and actual placement was very low (kappa = .09). Implications of these findings for clinical research, practice, policy, and training are discussed.
准确地将儿童分配到最合适的护理级别被广泛认为是很重要的。管理式医疗公司进行利用情况审查，在审查中他们使用书面安置标准来监测客户被分配的护理级别。然而，尚无研究考察临床医生执行这项任务的能力。在本研究中，开发了由48个变量组成的47份儿童和青少年临床概况。18名接受过使用其机构护理级别指南培训的临床医生，对这些概况做出护理级别决策。他们在将儿童分配到适当护理级别方面的评判者间信度接近于零（kappa = 0.07）。客户安置与实际安置之间存在微弱的、具有统计学意义的相关性，但客户安置与实际安置之间经机遇校正的一致性非常低（kappa = 0.09）。讨论了这些发现对临床研究、实践、政策和培训的意义。
