Measuring Acceptability of Clinical Decision Rules: Validation of the Ottawa Acceptability of Decision Rules Instrument (OADRI) in Four Countries
Measuring Acceptability of Clinical Decision Rules: Validation of the Ottawa Acceptability of Decision Rules Instrument (OADRI) in Four Countries
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DOI：
10.1177/0272989x09344747
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发表时间：
2010-05-01
影响因子：
3.6
通讯作者：
Stiell, Ian G.
中科院分区：
文献类型：
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作者：
Brehaut, Jamie C.;Graham, Ian D.;Stiell, Ian G.
背景临床决策规则可以使临床医生、患者和卫生系统受益，但它们涉及相当大的前期开发成本，并且必须为目标受众所接受。没有任何现有文书衡量一项规则的可接受性。目前的研究验证了这种工具。方法.作者在最近制定的2项规则（加拿大C-Spine规则（C-Spine）和加拿大CT头部规则（CT-Head））的背景下，通过邮寄调查向来自4个地区（澳大利亚、加拿大、英国和美国）的急诊医生实施了渥太华决策规则可接受性工具（OADRI）。12个项目的工具的结构效度进行了评估的假设检验。结果正如先验假设所预测的那样，OADRI得分1）规则使用者高于非使用者，2）使用规则的人“所有时间”比“大部分时间”比“一些时间”更高，3）考虑使用规则的非使用者比不考虑使用规则的人更高。我们还研究了受访者表示不会使用这些规则的明确原因。OADRI中的项目占不认为规则可接受的原因的85.5%（C-Spine）和90.2%（CT-Head）。结论. OADRI是一个简单的12项工具，用于评估临床医生对规则的接受程度。潜在的用途包括在开发过程中比较多个“protorule”，在实施之前检查规则对新受众的可接受性，通过知识翻译干预指出规则使用的障碍，并可能作为未来规则使用的替代措施。
Background. Clinical decision rules can benefit clinicians, patients, and health systems, but they involve considerable up-front development costs and must be acceptable to the target audience. No existing instrument measures the acceptability of a rule. The current study validated such an instrument. Methods. The authors administered the Ottawa Acceptability of Decision Rules Instrument (OADRI) via postal survey to emergency physicians from 4 regions (Australasia, Canada, United Kingdom, and United States), in the context of 2 recently developed rules, the Canadian C-Spine Rule (C-Spine) and the Canadian CT Head Rule (CT-Head). Construct validity of the 12-item instrument was evaluated by hypothesis testing. Results. As predicted by a priori hypotheses, OADRI scores were 1) higher among rule users than nonusers, 2) higher among those using the rule "all of the time" v. "most of the time" v. "some of the time," and 3) higher among rule nonusers who would consider using a rule v. those who would not. We also examined explicit reasons given by respondents who said they would not use these rules. Items in the OADRI accounted for 85.5% (C-Spine) and 90.2% (CT-Head) of the reasons given for not considering a rule acceptable. Conclusions. The OADRI is a simple, 12-item instrument that evaluates rule acceptability among clinicians. Potential uses include comparing multiple "protorules" during development, examining acceptability of a rule to a new audience prior to implementation, indicating barriers to rule use addressable by knowledge translation interventions, and potentially serving as a proxy measure for future rule use.