Accuracy of health-related quality of life assessment: what is the benefit of incorporating patients' preferences for domain functioning?

This study investigated the accuracy benefit of incorporating patients' preferences for domains of functioning into health-related quality of life (HRQOL) measurement. Using policy-capturing techniques, 102 medical outpatients judged the HRQOL of 16 scenarios describing varying levels of functioning in 3 domains. For each participant, regression analysis determined relative domain preferences and 2 decision models were built: one incorporating (preference-weighted) and one ignoring (equally weighted) domain preferences. To assess accuracy, the average proportion of judgment variance accounted for by each model was determined and both accounted for approximately 50%. However, for patients showing the greatest differences in importance across domains, the preference-weighted model was more accurate. Findings are discussed in the context of enhancing HRQOL assessment.

A prospective study to select and evaluate anesthesiology residents: phase I, the critical incident technique.

STUDY OBJECTIVE: To develop categories of behavior that define an applicant's aptitude for anesthesia, and to attempt to determine the relative importance of these behaviors to successful residency performance. DESIGN: Prospective open study. SETTING: Anesthesia residencies at three midwest university teaching hospitals. INTERVENTIONS: Using a structured interview format known as the critical incident technique, faculty anesthesiologists were asked to describe examples of effective and ineffective behaviors observed among anesthesia residents during the twelve months prior to the interview. MEASUREMENTS AND MAIN RESULTS: Interviews initially held with 34 anesthesiologists generated 172 incidents. These incidents formed the basis for a categorization analysis performed by two anesthesiologists. Six categories were developed: preparedness, interpersonal skills, response to teaching, data monitoring, technical skills, and emergency situations. Validation of these categories was confirmed with three subsequent interviews, in which 92 anesthesiologists generated 475 incidents. Most incidents were found to conform to the previously defined categories using a reallocation index with a range of 0.70 to 0.80. The category "technical skills" fell below the defined range. Over 60 percent of the incidents involved noncognitive personal attributes: preparedness, interpersonal skills, and response to teaching. CONCLUSION: Effective behavior in six categories identifies an applicant's aptitude for anesthesia. Selection of residents may be enhanced by routinely assessing noncognitive characteristics.