Ashley Siems1, Russell Banks2, Richard Holubkov2, Kathleen L Meert3, Christian Bauerfeld3, David Beyda4, Robert A Berg5, Yonca Bulut6, Randall S Burd1, Joseph Carcillo7, J Michael Dean2, Eleanor Gradidge4, Mark W Hall8, Patrick S McQuillen9, Peter M Mourani10, Christopher J L Newth11, Daniel A Notterman12, Margaret A Priestley5, Anil Sapru6, David L Wessel1, Andrew R Yates8, Athena F Zuppa5, Murray M Pollack13. 1. School of Medicine and Health Sciences, The George Washington University and Children's National Health System, Washington, District of Columbia. 2. School of Medicine, University of Utah, Salt Lake City, Utah. 3. Wayne State University and Children's Hospital of Michigan, Detroit, Michigan. 4. College of Medicine-Phoenix, University of Arizona and Phoenix Children's Hospital, Phoenix, Arizona. 5. Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. 6. University of California, Los Angeles and University of California, Los Angeles Mattel Children's Hospital, California. 7. University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania. 8. Nationwide Children's Hospital, Columbus, Ohio. 9. University of California, San Francisco and University of California, San Francisco Benioff Children's Hospital, San Francisco, California. 10. University of Colorado and Children's Hospital of Colorado, Denver, Colorado. 11. Keck School of Medicine, University of Southern California and Children's Hospital Los Angeles, Los Angeles, California; and. 12. Princeton University, Princeton, New Jersey. 13. School of Medicine and Health Sciences, The George Washington University and Children's National Health System, Washington, District of Columbia; mpollack@childrensnational.org.
Abstract
BACKGROUND AND OBJECTIVES: Chart reviews are frequently used for research, care assessments, and quality improvement activities despite an absence of data on reliability and validity. We aim to describe a structured chart review methodology and to establish its validity and reliability. METHODS: A generalizable structured chart review methodology was designed to evaluate causes of morbidity or mortality and to identify potential therapeutic advances. The review process consisted of a 2-tiered approach with a primary review completed by a site physician and a short secondary review completed by a central physician. A total of 327 randomly selected cases of known mortality or new morbidities were reviewed. Validity was assessed by using postreview surveys with a Likert scale. Reliability was assessed by percent agreement and interrater reliability. RESULTS: The primary reviewers agreed or strongly agreed in 94.9% of reviews that the information to form a conclusion about pathophysiological processes and therapeutic advances could be adequately found. They agreed or strongly agreed in 93.2% of the reviews that conclusions were easy to make, and confidence in the process was 94.2%. Secondary reviewers made modifications to 36.6% of cases. Duplicate reviews (n = 41) revealed excellent percent agreement for the causes (80.5%-100%) and therapeutic advances (68.3%-100%). κ statistics were strong for the pathophysiological categories but weaker for the therapeutic categories. CONCLUSIONS: A structured chart review by knowledgeable primary reviewers, followed by a brief secondary review, can be valid and reliable.
BACKGROUND AND OBJECTIVES: Chart reviews are frequently used for research, care assessments, and quality improvement activities despite an absence of data on reliability and validity. We aim to describe a structured chart review methodology and to establish its validity and reliability. METHODS: A generalizable structured chart review methodology was designed to evaluate causes of morbidity or mortality and to identify potential therapeutic advances. The review process consisted of a 2-tiered approach with a primary review completed by a site physician and a short secondary review completed by a central physician. A total of 327 randomly selected cases of known mortality or new morbidities were reviewed. Validity was assessed by using postreview surveys with a Likert scale. Reliability was assessed by percent agreement and interrater reliability. RESULTS: The primary reviewers agreed or strongly agreed in 94.9% of reviews that the information to form a conclusion about pathophysiological processes and therapeutic advances could be adequately found. They agreed or strongly agreed in 93.2% of the reviews that conclusions were easy to make, and confidence in the process was 94.2%. Secondary reviewers made modifications to 36.6% of cases. Duplicate reviews (n = 41) revealed excellent percent agreement for the causes (80.5%-100%) and therapeutic advances (68.3%-100%). κ statistics were strong for the pathophysiological categories but weaker for the therapeutic categories. CONCLUSIONS: A structured chart review by knowledgeable primary reviewers, followed by a brief secondary review, can be valid and reliable.
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