Little is known about current practices in high-value care (HVC) bedside teaching. A lack of instruments for measuring bedside HVC behaviors confounds efforts to assess the impact of curricular interventions. The authors aimed to define observable HVC concepts by developing an instrument to measure the content and frequency of HVC discussions.
The authors developed the HVC Rounding Tool in four iterative phases, using Messick’s validity framework. Phases 1 and 2 were designed to collect evidence of content validity, Phases 3 and 4 to collect evidence of response process and internal structure. Phase 1 identified HVC topics within the literature. Phase 2 used a modified Delphi approach for construct definition and tool development. Through two rounds, the Delphi panel narrowed 16 HVC topics to 11 observable items, categorized into three domains (quality, cost, and patient values). Phase 3 involved rater training and creation of a codebook. Phase 4 involved three iterations of instrument piloting. Six trained raters, in pairs, observed bedside rounds during 148 patient encounters in 2016. Weighted kappas for each domain demonstrated improvement from the first to third iteration: Quality increased from 0.65 (95% CI 0.55–0.79) to 1.00, cost from 0.58 (95% CI 0.4–0.75) to 0.96 (95% CI 0.80–1.00), and patient values from 0.41 (95% CI 0.19–0.68) to 1.00. Percent positive agreement for all domains improved from 65.3% to 98.1%. This tool, the first with established validity evidence, addresses an important educational gap for measuring the translation of HVC from theoretical knowledge to bedside practice.
Supplemental Digital Content is available in the text.
C.E. McDaniel is clinical assistant professor, Department of Pediatrics, University of Washington, Seattle, Washington.
A.A. White is associate professor, Department of Medicine, University of Washington, Seattle, Washington.
M.C. Bradford is a biostatistician, Center for Clinical and Translational Research, Seattle Children’s Research Institute, Seattle, Washington.
C.D. Sy is clinical instructor, Department of Medicine, University of Washington, Seattle, Washington.
T. Chen is clinical instructor, Department of Medicine, University of Washington, Seattle, Washington.
D. Brock is associate professor, Department of Family Medicine, University of Washington, Seattle, Washington.
J. Foti is clinical associate professor, Department of Pediatrics, University of Washington, Seattle, Washington.
J.B. Beck is assistant professor, Department of Pediatrics, University of Washington, Seattle, Washington.
Supplemental digital content for this article is available at http://links.lww.com/ACADMED/A477.
Funding/Support: Funding for this study was provided through a Seattle Children’s Academic Enrichment Fund grant (LAN 24080047, AEF Beck 2015). Statistical support was provided by the Institute for Translational Health Sciences (ITHS) through the University of Washington. The ITHS is supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under award number UL1 TR000423. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Other disclosures: None reported.
Ethical approval: Approval for this project was obtained from Seattle Children’s Hospital Institutional Review Board, which found the project to be exempt (10/29/2015, ID# Beck 15798).
Correspondence should be addressed to Corrie McDaniel, Seattle Children’s Hospital, 4800 Sandpoint Way NE, M/S FA.2.115, PO Box 5371, Seattle, WA 98105; telephone: (206) 987-5888; e-mail: email@example.com.