Exploring subjectivity in competency-based assessment judgements of assessors.

AIM: The aim of this research was to measure variations in assessors' judgements of a student dietitian's performance and to explore the influence of group discussion on their judgements. METHODS: The assessments of a student's performance, as observed from a video recording of an authentic nutrition consultation, were measured pre- and post-group discussion by 26 experienced assessors using a mixed-methods questionnaire. The instrument included a validated 7-point visual analogue scale (VAS) rating (1 = novice; 7 = competent), a qualitative global description of performance and an assessor's confidence rating (1 = not at all confident; 10 = extremely confident). Scales were analysed descriptively and qualitative responses coded for key themes. RESULTS: No agreement was found in assessors' rating in either the pretest (median = 4, range = 5) or post-test (median = 4, range = 4); however, the discussion led 78% of participants (20/26) to change their VAS ratings (9/26) and/or confidence levels (16/26). Three themes emerged from the thematic analysis of the participants' global descriptions of performance: (i) discourse supports assessors to justify their judgements, identify assumptions and learn from the observations of others; (ii) discourse leads assessors to more holistic judgements; and (iii) multiple sources of evidence and student reflections are necessary for credible judgement. CONCLUSIONS: This research questions the notion that 'actual' performance can be objectively measured and, rather, considers assessments as 'interpretations'. This research calls for an integrated interpretivist student-centred approach to competency-based assessment.

Impact of Society of Cardiovascular Patient Care accreditation on quality: an ACTION Registry®-Get With The Guidelines™ analysis.

BACKGROUND: The Society of Cardiovascular Patient Care (SCPC) accredits hospital acute coronary syndrome management. The influence of accreditation on the subset of patients diagnosed with acute myocardial infarction (AMI) is unknown. Our purpose was to describe the association between SCPC accreditation and hospital quality metric performance among AMI patients enrolled in ACTION Registry-GWTG (ACTION-GWTG). This program is a voluntary registry that receives self-reported hospital AMI quality metrics data and provides quarterly feedback to 487 US hospitals. METHODS: Using urban nonacademic hospital registry data from January 1, 2007, to June 30, 2010, we performed a 1 to 2 matched pairs analysis, selecting 14 of 733 (1.9%) SCPC accredited and 28 of 309 (9.1%) nonaccredited registry facilities to compare changes in quality metrics between the year before and after SCPC accreditation. RESULTS: All hospitals improved quality metric compliance during the study period. Nonaccredited hospitals started with slightly lower rates of AMI composite score 1 year before accreditation. Although improvement compared with baseline was greater for nonaccredited hospitals (odds ratio = 1.27; 95% confidence interval: 1.20, 1.35) than accredited hospitals (odds ratio = 1.15; 95% confidence interval: 1.07, 1.23) (P = 0.022), the group ended with similar compliance scores (92.1% vs. 92.2%, respectively). Improvements in evaluating left ventricular function (P = 0.0001), adult smoking cessation advice (P = 0.0063), and cardiac rehab referral (P = 0.0020) were greater among nonaccredited hospitals, whereas accredited hospitals had greater improvement in discharge angiotensin-converting-enzyme inhibitor or angiotensin II receptor blocker use for left ventricular systolic dysfunction (P = 0.0238). CONCLUSIONS: All hospitals had high rates of quality metric compliance and finished with similar overall AMI performance composite scores after 1 year.

Characteristics of hospital observation services: a society of cardiovascular patient care survey.

INTRODUCTION: Little is known about the setting in which observation services are provided, or how observation patients are managed in settings such as accredited cardiovascular patient care centers. OBJECTIVE: To describe the characteristics of observation services in accredited Cardiovascular Patient Care hospitals, or those seeking accreditation. METHODS: This is a cross-sectional survey of hospitals either accredited by the Society of Cardiovascular Patient Care, or considering accreditation in 2010. The survey was a web-based free service linked to an e-mail sent to Cardiovascular Patient Care coordinators at the respective institutions. The survey included 17 questions which focused on hospital characteristics and observation services, specifically management, settings, staffing, utilization, and performance data. RESULTS: Of the 789 accredited hospitals, 91 hospitals (11.5%) responded to the survey. Responding hospitals had a median of 250 inpatient beds (interquartile range [IQR] 277), 32.5 emergency department (ED) beds or hall spots, with an average annual ED census of 41,660 (IQR 30,149). These hospitals had an average of 8 (IQR 9) observation unit beds whose median length of stay (LOS) was 19 hours (IQR 8.1), with a discharge rate of 89.1% (IQR 15). There was an average of 1 observation bed to 3.8 ED beds. Observation units were most commonly administered by emergency medicine (48.5%), but staffed by a broad spectrum of specialties. Nonemergency medicine units had longer LOSs, which were not significant. Most common conditions were chest pain and abdominal pain. CONCLUSIONS: Accredited chest pain centers have observation units whose LOSs and discharge rates are comparable to prior studies with utilization patterns that may serve as benchmarks for similar hospitals.

Chest pain center accreditation is associated with better performance of centers for Medicare and Medicaid services core measures for acute myocardial infarction.

The aim of this study was determine whether hospitals accredited by the Society of Chest Pain Centers hospitals (accredited chest pain centers [ACPCs]) are associated with better performance regarding Centers for Medicare and Medicaid Services core measures for acute myocardial infarction (AMI) than nonaccredited hospitals. The study was a retrospective, observational cohort study of hospitals reporting Centers for Medicare and Medicaid Services core measures for AMI from January 1, 2005, to December 31, 2005, on the basis of the presence or absence of Society of Chest Pain Centers accreditation. Data were obtained from the Web sites of the Centers for Medicare and Medicaid Services (Hospital Compare), Society of Chest Pain Centers listings, and the American Hospital Directory. Groups were compared in terms of demographics and mean percentage compliance with all 8 AMI core measures. Student's t test, chi-square analysis, and logistic regression were used to analyze bivariate relations. Multivariate logistic regression models used a propensity-score adjustment factor. Of the 4,197 hospitals that reported core measures for AMI, 178 (4%) were accredited and 4,019 (96%) were not. ACPCs had been accredited for an average of 12 months and were larger (378 vs 204 beds), more often teaching hospitals (52% vs 30%), and more often urban (95% vs 69%) (all p <0.0001). There were 395,250 patients with AMIs, of whom 55,418 (14%) presented to ACPCs and 339,832 (86%) presented to nonaccredited hospitals. There was significantly greater compliance with all 8 AMI core measures at ACPCs (p <0.0001), except for lytic therapy <30 minutes after arrival (p = 0.04), for which unadjusted performance was the same. In conclusion, ACPCs were associated with better compliance with Centers for Medicare and Medicaid Services core measures and saw a greater proportion of patients with AMIs.