Way B B, Allen M H, Mumpower J L, Stewart T R, Banks S M
Center for the Study of Issues in Public Mental Health, Albany, NY, USA.
Am J Psychiatry. 1998 Oct;155(10):1423-8. doi: 10.1176/ajp.155.10.1423.
The authors' purpose in this study was to investigate the interrater agreement among psychiatrists in psychiatric emergency service settings. The interrater reliability of many of the key concepts in psychiatric emergency service settings has not been studied.
Videotapes of 30 psychiatric emergency service patient assessment interviews conducted by psychiatrists were shown to eight experienced psychiatric emergency service psychiatrists. The eight psychiatrists rated each videotape on dimensions such as severity of depression and psychosis and recommended a disposition for each patient. Interrater reliability was then explored.
The level of agreement (intraclass correlation coefficient) among the reviewing psychiatrists was higher for psychosis and substance abuse but lower for psychopathology, impulse control problems, danger to self, and disposition. The reviewers' disposition recommendations did not match well with the assessing psychiatrist's actual disposition, but comparisons with actual practice should be considered only suggestive.
Psychiatric emergency service assessments need improvement. This may be accomplished by exploring the underlying structure of psychiatric emergency service concepts, the creation and validation of structured assessment tools, and the creation of practice guidelines.
作者开展本研究的目的是调查精神科急诊服务环境中精神科医生之间的评分者间一致性。精神科急诊服务环境中许多关键概念的评分者间信度尚未得到研究。
精神科医生对30例精神科急诊服务患者评估访谈的录像带展示给8位经验丰富的精神科急诊服务精神科医生。这8位精神科医生对每一盘录像带在抑郁和精神病严重程度等维度上进行评分，并为每位患者推荐处置方式。然后探讨评分者间信度。
在复查精神科医生中，关于精神病和药物滥用的一致性水平（组内相关系数）较高，但在精神病理学、冲动控制问题、对自身的危险和处置方面较低。复查者的处置建议与评估精神科医生的实际处置不太相符，但与实际做法的比较应仅视为具有启发性。
精神科急诊服务评估需要改进。这可以通过探索精神科急诊服务概念的潜在结构、创建和验证结构化评估工具以及制定实践指南来实现。
