[Analyzing the Informational Content of Observational and Rating Data]. / Analyse des Informationsgehalts von Merkmalseinschätzungen und Beurteilungsdaten.

In rehabilitation, decisions are often based on ratings or judgements made by rehabilitation patients, therapists or peer-reviewers. But, depending on aspects of the assessment setting, ratings of an issue (e. g., quality of communication, quality of health care) may vary systematically or due to stochastic error components. Rating scores may be affected by the properties of the rater, raters' perspective (e. g., self- vs. external ratings), rating situation or measurement point in time, respectively. Hence, rating scores should be considered as composite scores comprising several systematic information aspects. Generalizability theory provides an analytical framework allowing to decompose underlying information facets and to determine their influence on the obtained rating data. First, a differentiated model can be identified ensuring a more valid data interpretation (generalizability aspect). Second, well-founded recommendations enhancing reliability and validity of the assessment may be derived (decision aspect). In this article we demonstrate how to apply generalizability theory to enhance the clarity of the informational content of ratings and to foster rating quality in typical rehabilitation settings.

[Patient Participation in Child and Adolescent Psychiatry - A Scoping Review]. / Partizipation von Patienten im Kontext der stationären Kinder- und Jugendpsychiatrie ­ ein Scoping Review.

Patient Participation in Child and Adolescent Psychiatry - A Scoping Review The present study deals with the concept of participation in inpatient child- and adolescent mental health care. Aim is to analyse theoretical constructs in the light of a literature review on participation as an important method to implement patient autonomy in the specific context. The potential for conflict of patient autonomy as a greater principle and the absence of literature reviews on the topic make this study essential. The method is a scoping-review. 978 texts from three central databases have been screened for title and abstract, 27 have been included. The results show arguments, barriers and methods of participation. Most of the arguments are utilitarian: positive effects on patients, therapists and the hospital. On the other hand, there are multiple barriers of implementation: willingness of physicians, reticence of patients and systemic barriers. Structures of cooperation, key figures and interactive information brochures have already been used as methods of participation. In conclusion, a contextual concept of participation is proposed: Shared Care Planning. It is meant to be independent from the capacity to give informed consent and underlines the importance of day-to-day issues. It calls for the consideration of the mentioned barriers and a high flexibility of participation methods.

The Acceptance, Usability, and Utility of a Web Portal for Back Pain as Recommended by Primary Care Physicians: Qualitative Interview Study With Patients.

BACKGROUND: An ever-increasing number of patients seek health information via the internet. However, there is an overabundance of differing, often low-quality information available, while a lack of health literacy makes it difficult for patients to understand and assess the quality and trustworthiness of the information at hand. The web portal tala-med was thus conceived as an evidence-based, up-to-date, and trustworthy information resource for lower back pain (LBP), which could be used by primary care physicians (PCPs) and patients during and following consultations for LBP. The current evidence demonstrates that patients with LBP could benefit from web portals. However, the use of such portals by patients remains low, thus limiting their effectiveness. Therefore, it is important to explore the factors that promote or hinder the use of web portals and investigate how patients perceive their usability and utility. OBJECTIVE: In this study, we investigated the acceptance, usability, and utility of the web portal tala-med from the patient perspective. METHODS: This qualitative study was based on telephone interviews with patients who had access to the web portal tala-med from their PCP. We used a semistructured interview guide that consisted of questions about the consultation in which patients were introduced to tala-med, in addition to questions regarding patient perceptions, experiences, and utilization of tala-med. The interviews were recorded, transcribed, and analyzed through framework analysis. RESULTS: A total of 32 half-hour interviews were conducted with 16 female and 16 male patients with LBP. We identified 5 themes of interest: the use of tala-med by PCPs during the consultation, the use of tala-med by patients, its usability, added values derived from its use, and the resultant effects of using tala-med. PCPs used tala-med as an additional information resource for their patients and recommended the exercises. The patients appreciated these exercises and were willing to use tala-med at home. We also identified factors that promoted or hindered the use of tala-med by patients. Most patients rated tala-med positively and considered it a clear, comprehensible, trustworthy, and practical resource. In particular, the trustworthiness of tala-med was seen as an advantage over other information resources. The possibilities offered by tala-med to recap and reflect on the contents of consultations in a time-flexible and independent manner was perceived as an added value to the PCP consultation. CONCLUSIONS: Tala-med was well accepted by patients and appeared to be well suited to being used as an add-on to PCP consultations. Patient perception also supports its usability and utility. Tala-med may therefore enrich consultations and assist patients who would otherwise be unable to find good-quality web-based health information on LBP. In addition, our findings support the future development of digital health platforms and their successful use as a supplement to PCP consultations. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1186/s12875-019-0925-8.

Handling Missing Data in the Short Form-12 Health Survey (SF-12): Concordance of Real Patient Data and Data Estimated by Missing Data Imputation Procedures.

If information on single items in the Short Form-12 health survey (SF-12) is missing, the analysis of only complete cases causes a loss of statistical power and, in case of nonrandom missing data (MD), systematic bias. This study aimed at evaluating the concordance of real patient data and data estimated by different MD imputation procedures in the items of the SF-12 assessment. For this ends, MD were examined in a sample of 1,137 orthopedic patients. Additionally, MD were simulated (a) in the subsample of orthopedic patients exhibiting no MD (n = 810; 71%) as well as (b) in a sample of 6,970 respondents representing the German general population (95.8% participants with complete data) using logistic regression modelling. Simulated MD were replaced by mean values as well as regression-, expectation-maximization- (EM-), and multiple imputation estimates. Higher age and lower education were associated with enhanced probabilities of MD. In terms of accuracy in both data sets, the EM-procedure (ICC2,1 = .33-.72) outperformed alternative estimation approaches substantially (e.g., regression imputation: ICC2,1 = .18-.48). The EM-algorithm can be recommended to estimate MD in the items of the SF-12, because it reproduces the actual patient data most accurately.

Variance components of ratings of physician-patient communication: A generalizability theory analysis.

BACKGROUND: The ratings of physician-patient communication are an important indicator of the quality of health care delivery and provide guidance for many important decisions in the health care setting and in health research. But there is no gold standard to assess physician-patient communication. Thus, depending on the specific measurement condition, multiple sources of variance may contribute to the total score variance of ratings of physician-patient communication. This may systematically impair the validity of conclusions drawn from rating data. OBJECTIVE: To examine the extent to which different measurement conditions and rater perspectives, respectively contribute to the variance of physician-patient communication ratings. METHODS: Variance components of ratings of physician-patient communication gained from 32 general practitioners and 252 patients from 25 family practices in Germany were analyzed using generalizability theory. The communication dimensions "shared decision making", "effective and open communication" and "satisfaction" were considered. RESULTS: Physician-patient communication ratings most substantially reflect unique rater-perspective and communication dimension combinations (32.7% interaction effect). The ratings also represented unique physician and rater-perspective combinations (16.3% interaction effect). However, physicians' communication behavior and the observed communication dimensions revealed only a low extent of score variance (1% physician effect; 3.7% communication dimension effect). Approximately half of the variance remained unexplained (46.2% three-way interaction, confounded with error). CONCLUSION: The ratings of physician-patient communication minimally reflect physician communication skills in general. Instead, these ratings exhibit primarily differences among physicians and patients in their tendency to perceive shared decision making and effective and open communication and to be satisfied with communication, regardless of the communication behavior of physicians. Rater training and assessing low inferential ratings of physician-patient communication dimensions should be considered when subjective aspects of rater perspectives are not of interest.

Agreement of physician and patient ratings of communication in medical encounters: A systematic review and meta-analysis of interrater agreement.

OBJECTIVE: To determine the agreement of physician and patient ratings of communication in medical face-to-face consultations. METHODS: A systematic search of twelve databases was conducted. Studies investigating agreement between physician and patient ratings of communication in medical face-to-face encounters and reporting interrater agreement were included. Methodological quality was assessed, and study characteristics and physician-patient agreement were narratively summarized. Meta-analysis was conducted for a subsample of the included studies investigating shared decision making. RESULTS: Of the 17 included studies, ten studies did not demonstrate any correspondence between physician and patient ratings. The remaining seven studies revealed poor to fair absolute agreement (κ between .13 and .42; κw between .31 and .49; 95% CI 0.13 - 0.76) and poor to moderate consistency (r = .17 and .06; rpolyc between .39 and .63; p < .05). Meta-analysis of six studies yielded small association (rpolyc = .15). CONCLUSION: Physicians and patients evaluate communication differently and at best, only slightly agree in their ratings, indicating that the construct of communication is not measurable in a stable manner. PRACTICE IMPLICATIONS: Decision makers and researchers should be aware that they assess different aspects of communication, depending on the perspective examined. PROSPERO registration number: CRD42019120065.