Christopher E Knoepke1,2, Larry A Allen1,2, Karen Sepucha3, Frederick A Masoudi1, Jean Kutner3, Paul Varosy1,4, David Magid1, Daniel D Matlock2,5,6. 1. Department of Medicine, Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado, USA. 2. Adult and Child Consortium for Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, Colorado, USA. 3. Department of Medicine, Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA. 4. VA Eastern Colorado Health Care System, Denver, Colorado, USA. 5. Department of Medicine, Division of Geriatric Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA. 6. VA Eastern Colorado Geriatric Research Education and Clinical Center, Denver, Colorado, USA.
Abstract
BACKGROUND: CMS reimbursement guidelines for implantable cardioverter-defibrillators (ICDs) include mandated shared decision making (SDM), but without any manner of assessing the quality of decisions made. We developed and tested a scale meant to assess patients' knowledge of and preferences specific to ICDs. Such a tool would assess these constructs in the clinical environment, targeting resources and support for patients considering a primary prevention ICD. METHODS: Development of the ICD decision quality (ICD-DQ) scale included (1) item creation, (2) content validation using surveys of patients (n = 23) and clinicians (n = 31), and (3) examination of validity and reliability using a survey of patients who previously received an ICD (n = 295, response rate = 72%). RESULTS: The final scale consists of 12 knowledge and 8 preference items. With respect to content validity, clinician and patient respondents agreed on the importance of 19 of 24 candidate knowledge items (79%), and 9 of 11 treatment preference items (81%). Knowledge items exhibited moderate internal validity (α = 0.62, 1 factor), strong test-retest reliability (mean % correct at first administration = 59%, 62% at follow-up, P > .1) and discriminant validity (59% correct for patients, 93% among cardiologists). Short versions of the ICD-DQ were developed for clinical settings, the scores from both of which correlated with the long version in this cohort (11-item (r = 0.90) and a 5-item (r = 0.75)). CONCLUSIONS: The ICD-DQ fills a critical gap in measuring the quality of patients' ICD decisions. They may be used to evaluate the effectiveness of patient decision aids or the quality of SDM in clinical practice.
BACKGROUND: CMS reimbursement guidelines for implantable cardioverter-defibrillators (ICDs) include mandated shared decision making (SDM), but without any manner of assessing the quality of decisions made. We developed and tested a scale meant to assess patients' knowledge of and preferences specific to ICDs. Such a tool would assess these constructs in the clinical environment, targeting resources and support for patients considering a primary prevention ICD. METHODS: Development of the ICD decision quality (ICD-DQ) scale included (1) item creation, (2) content validation using surveys of patients (n = 23) and clinicians (n = 31), and (3) examination of validity and reliability using a survey of patients who previously received an ICD (n = 295, response rate = 72%). RESULTS: The final scale consists of 12 knowledge and 8 preference items. With respect to content validity, clinician and patient respondents agreed on the importance of 19 of 24 candidate knowledge items (79%), and 9 of 11 treatment preference items (81%). Knowledge items exhibited moderate internal validity (α = 0.62, 1 factor), strong test-retest reliability (mean % correct at first administration = 59%, 62% at follow-up, P > .1) and discriminant validity (59% correct for patients, 93% among cardiologists). Short versions of the ICD-DQ were developed for clinical settings, the scores from both of which correlated with the long version in this cohort (11-item (r = 0.90) and a 5-item (r = 0.75)). CONCLUSIONS: The ICD-DQ fills a critical gap in measuring the quality of patients' ICD decisions. They may be used to evaluate the effectiveness of patient decision aids or the quality of SDM in clinical practice.
Authors: Karen R Sepucha; Carrie A Levin; Ekeoma E Uzogara; Michael J Barry; Annette M O'Connor; Albert G Mulley Journal: Patient Educ Couns Date: 2008-08-20
Authors: Arthur J Moss; Wojciech Zareba; W Jackson Hall; Helmut Klein; David J Wilber; David S Cannom; James P Daubert; Steven L Higgins; Mary W Brown; Mark L Andrews Journal: N Engl J Med Date: 2002-03-19 Impact factor: 91.245
Authors: Gust H Bardy; Kerry L Lee; Daniel B Mark; Jeanne E Poole; Douglas L Packer; Robin Boineau; Michael Domanski; Charles Troutman; Jill Anderson; George Johnson; Steven E McNulty; Nancy Clapp-Channing; Linda D Davidson-Ray; Elizabeth S Fraulo; Daniel P Fishbein; Richard M Luceri; John H Ip Journal: N Engl J Med Date: 2005-01-20 Impact factor: 91.245
Authors: Dan D Matlock; Carolyn T Nowels; Frederick A Masoudi; William H Sauer; David B Bekelman; Deborah S Main; Jean S Kutner Journal: Pacing Clin Electrophysiol Date: 2011-10-05 Impact factor: 1.976
Authors: Nathan E Goldstein; Rachel Lampert; Elizabeth Bradley; Joanne Lynn; Harlan M Krumholz Journal: Ann Intern Med Date: 2004-12-07 Impact factor: 25.391
Authors: Daniel B Mark; Kevin J Anstrom; Jie L Sun; Nancy E Clapp-Channing; Anastasios A Tsiatis; Linda Davidson-Ray; Kerry L Lee; Gust H Bardy Journal: N Engl J Med Date: 2008-09-04 Impact factor: 91.245