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Published on: February 16, 2011
Measuring guideline-concordant care when recommendations require clinical judgment: a mixed methods approach
Vera Camões-Costa1, Jennifer Neil2, Danielle Mazza1
1School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia.
Introduction:
General practitioners (GPs) face challenges in diagnosing and managing work-related mental health conditions. In Australia, this prompted the development of a national clinical guideline (the Guideline) to support high-quality care. However, measuring the implementation of recommendations that require clinical judgment remains methodologically challenging.
Objective:
This study describes an approach to developing and testing a guideline-specific tool to assess concordance with recommendations in the context of an implementation trial.
Methods:
We used an exploratory sequential mixed methods design. Semi-structured interviews were conducted with 20 individuals with lived experience of work-related mental health conditions. The interview data informed personas and case studies, which were converted into 18 video vignettes simulating GP-patient consultations. Each vignette was mapped to a checklist of clinical indicators from the Guideline and paired with one multiple-choice and two short-answer questions. A scoring rubric (0-3 points per vignette) was developed and pilot-tested with three groups: GPs familiar with the Guideline, GPs unfamiliar with it, and medical/research students. Vignette content and questions were refined for internal consistency before use in a national implementation trial.
Results:
Internal consistency was acceptable (Cronbach's α = 0.74). In the IMPRovE trial, participants completed three vignettes per time point (score range: 0-9). Inter-rater reliability was almost perfect (Cohen's κ = 0.92) from 873 responses across 97 GPs.
Conclusions:
This study offers a rigorous, context-sensitive method for evaluating guideline-concordant care where recommendations require clinical judgment. Successfully implemented in a national trial, this approach offers a replicable method for evaluating guideline implementation where recommendations require nuanced clinical judgment.
Improve Trial Registration:
ACTRN12620001163998, November 2020.
Spanish Abstract:
http://links.lww.com/IJEBH/A597.
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