Intra- and inter-rater reliability of an electronic health record audit used in a chiropractic teaching clinic system: an observational study
| Autor: | Anthony Ridding, Sean Abdulla, Sheilah Hogg-Johnson, H. Stephen Injeyan, Jocelyn Cox, Ngai Chow, Craig Jacobs |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Canada Inter-rater Standards Intraclass correlation Context (language use) Audit 03 medical and health sciences 0302 clinical medicine Cohen's kappa Medicine Electronic Health Records Humans Medical physics 030212 general & internal medicine Reliability (statistics) Accreditation Observer Variation business.industry 030503 health policy & services Health Policy Research Reproducibility of Results Reliability Checklist Chiropractic Inter-rater reliability Electronic health record EHR Public aspects of medicine RA1-1270 0305 other medical science business File audit |
| Zdroj: | BMC Health Services Research, Vol 21, Iss 1, Pp 1-11 (2021) BMC Health Services Research |
| ISSN: | 1472-6963 |
| Popis: | BackgroundThere is a dearth of information about health education clinical file audits in the context of completeness of records and demonstrating program-wide competency achievement. We report on the reliability of an audit instrument used for electronic health record (EHR) audits in the clinics of a chiropractic college in Canada.MethodsThe instrument is a checklist built within an electronic software application designed to pull data automatically from the EHR. It consists of a combination of 61 objective (n = 20) and subjective (n = 41) elements, representing domains of standards of practice, accreditation and in-house educational standards. Trained auditors provide responses to the elements and the software yields scores indicating the quality of clinical record per file.A convenience sample of 24 files, drawn randomly from the roster of 22 clinicians, were divided into three groups of eight to be completed by one of three auditors in the span of 1 week, at the end of which they were transferred to another auditor. There were four audit cycles; audits from cycles 1 and 4 were used to assess intra-rater (test-retest) reliability and audits from cycles 1, 2 and 3 were used to assess inter-rater reliability. Percent agreement (PA) and Kappa statistics (K) were used as outcomes. Scatter plots and intraclass correlation (ICC) coefficients were used to assess standards of practice, accreditation, and overall audit scores.ResultsAcross all 3 auditors test-retest reliability for objective items was PA 89% and K 0.75, and for subjective items PA 82% and K 0.63. In contrast, inter-rater reliability was moderate at PA 82% and K 0.59, and PA 70% and K 0.44 for objective and subjective items, respectively. Element analysis indicated a wide range of PA and K values inter-rater reliability of many elements being rated as poor. ICC coefficient calculations indicated moderate reliability for the domains of standards of practice, accreditation, and overall file scores.ConclusionThe file audit process has substantial test-retest reliability and moderate inter-rater reliability. Recommendations are made to improve reliability outcomes. These include modifying the audit checklist with a view of improving clarity of elements, and enhancing uniformity of auditor responses by increased training aided by preparation of an audit guidebook. |
| Databáze: | OpenAIRE |
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