Measuring Agreement Among Prehospital Providers and Physicians in Patient Capacity Determination

Abstract

ObjectivesIf a patient wishes to refuse treatment in the prehospital setting, prehospital providers and consulting emergency physicians must establish that the patient possesses the capacity to do so. The objective of this study is to assess agreement among prehospital providers and emergency physicians in performing patient capacity assessments.MethodsThis study involved 139 prehospital providers and 28 emergency medicine physicians. Study participants listened to 30 medical control calls pertaining to patient capacity and were asked to interpret whether the patients in the scenarios had the capacity to refuse treatment. Participants also reported their comfort level using modified Likert scales. Inter‐rater reliability was calculated utilizing Fleiss' and Model B kappa statistics. Fisher's exact tests were used to calculate p‐values comparing the proportion in each cohort that responded “no capacity.” Primary outcomes included inter‐rater reliability in the physician and prehospital provider cohorts.ResultsThe inter‐rater agreement between the physicians was low (Fleiss' kappa = 0.31, standard error [SE] =0.06; model‐based kappa = 0.18, SE = 0.04). Agreement was similarly low for the 135 prehospital providers (Fleiss' kappa = 0.30, SE = 0.06; model‐based kappa = 0.28, SE = 0.04). The difference between the proportion of physicians and prehospital providers who responded “no capacity” was statistically significant in five of 30 scenarios. Median prehospital provider and physician confidence, on a 1 to 4 scale, was 2.00 (Q1–Q3 = 1.00–3.00 for prehospital providers and Q1–Q3 =1.0–2.0 for physicians).ConclusionsThere was poor inter‐rater reliability in capacity determination between and among the prehospital provider and physician cohorts. This suggests that there is need for additional study and standardization of this task.

Validity and Reliability of Typhoid Risk Factors Questionnaire (TRFQ) in Gombe Metropolis, Gombe State, Nigeria

“…An expert panel comprising two epidemiologists, two public health professionals, two medical microbiologists, and two medical doctors assessed the content validity of each item in the questionnaire on a Likert scale ranging from "not relevant, somewhat relevant, quite relevant, to highly relevant." These responses were then analyzed using Fleiss' Multi-rater kappa to obtain the inter-rater agreement value at 95% CI (O'Connor et al, 2020). The value of kappa was inferred based on the following guide: values ≤ 0 indicate no agreement, 0.01-0.20 indicate none to a slight agreement, 0.21-0.40 as fair agreement, 0.41-0.60 as moderate agreement, 0.61-0.80 as substantial agreement, and 0.81-1.00 as almost perfect agreement (McHugh, 2012).…”