Reliability of the Peer-Review Process for Adverse Event Rating 英文参考文献.docVIP

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Reliability of the Peer-Review Process for Adverse Event Rating 英文参考文献.doc

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Reliability of the Peer-Review Process for Adverse Event Rating 英文参考文献

ReliabilityofthePeer-ReviewProcessforAdverseEvent Rating AlanJ.Forster1,2,3,4*,MonicaTaljaard3,5,CarolBennett3,4,CarlvanWalraven1,2,3,4 1TheOttawaHospital,Ottawa,Ontario,Canada,2DepartmentofMedicine,FacultyofMedicine,UniversityofOttawa,Ottawa,Ontario,Canada,3ClinicalEpidemiology Program,OttawaHospitalResearchInstitute,Ottawa,Ontario,Canada,4InstituteforClinicalEvaluativeSciences,Ottawa,Ontario,Canada,5DepartmentofEpidemiology andCommunityMedicine,UniversityofOttawa,Ottawa,Ontario,Canada Abstract Background: Adverse events are poor patient outcomes caused by medical care. Their identification requires the peer- reviewofpooroutcomes,whichmaybeunreliable.Combiningphysicianratingsmightimprovetheaccuracyofadverse eventclassification. Objective:Toevaluatethevariationinpeer-reviewerratingsofadverseoutcomes;determinetheimpactofthisvariationon estimates of reviewer accuracy; and determine the number of reviewers who judge an adverse event occurred that is requiredtoensurethatthetrueprobabilityofanadverseeventexceeded50%,75%or95%. Methods: Thirty physicians rated 319 case reports giving details of poor patient outcomes following hospital discharge. Theyratedwhethermedicalmanagementcausedtheoutcomeusingasix-pointordinalscale.Weconductedlatentclass analysestoestimatetheprevalenceofadverseeventsaswellasthesensitivityandspecificityofeachreviewer.Weusedthis model and Bayesian calculations to determine the probability that an adverse event truly occurred to each patient as functionoftheirnumberofpositiveratings. Results:Theoverallmedianscoreonthe6-pointordinalscalewas3(IQR2,4)buttheindividualratermedianscoreranged from a minimum of 1 (in four reviewers) to a maximum median score of 5. The overall percentage of cases rated as an adverseeventwas39.7%(3798/9570).Themediankappaforallpair-wisecombinationsofthe30reviewerswas0.26(IQR 0.16,0.42;Min=20.07,Max=0.62).Reviewersensitivityandspecificityforadverseeventclassificationrangedfrom0.06to 0.93and0.50to0.98,respectively.Theestimatedpre