the dundrum-1 structured professional judgment for triage to appropriate levels of therapeutic security retrospective-cohort validation study分流的dundrum-1结构化的职业判断适当的治疗水平安全验证回顾性队列研究.pdfVIP

Flynn et al. BMC Psychiatry 2011, 11:43 /1471-244X/11/43 RESEARCH ARTICLE Open Access The DUNDRUM-1 structured professional judgment for triage to appropriate levels of therapeutic security: retrospective-cohort validation study Grainne Flynn1,2, Conor O’Neill1,2, Clare McInerney1,2, Harry G Kennedy1,2* Abstract Background: The assessment of those presenting to prison in-reach and court diversion services and those referred for admission to mental health services is a triage decision, allocating the patient to the appropriate level of therapeutic security. This is a critical clinical decision. We set out to improve on unstructured clinical judgement. We collated qualitative information and devised an 11 item structured professional judgment instrument for this purpose then tested for validity. Methods: All those assessed following screening over a three month period at a busy remand committals prison (n = 246) were rated in a retrospective cohort design blind to outcome. Similarly, all those admitted to a mental health service from the same prison in-reach service over an overlapping two year period were rated blind to outcome (n = 100). Results: The 11 item scale had good internal consistency (Cronbach’s alpha = 0.95) and inter-rater reliability. The scale score did not correlate with the HCR-20 ‘historical’ score. For the three month sample, the receiver operating characteristic area under the curve (AUC) for those admitted to hospital was 0.893 (95% confidence interval 0.843 to 0.943). For the two year sample, AUC distinguished at each level between those admitted to open wards, low secure units or a medium/high secure service. Open wards v low secure units AUC = 0.805 (95% CI 0.680 to 0.930); low secure v medium/high secure AUC = 0.866, (95% CI 0.784 to 0.949). Item to outcome correlations were significant fo