Abstract
Efforts to establish support for the reliability of quality indicator data are ongoing. Most patients typically receive recommended care, therefore, the high-prevalence of event rates make statistical analysis challenging. This article presents a novel statistical approach recently used to estimate inter-rater agreement for the National Database for Nursing Quality Indicator pressure injury risk and prevention data. Inter-rater agreement was estimated by prevalence-adjusted kappa values. Data modifications were also done to overcome the convergence issue due to sparse cross-tables. Cohen's kappa values suggested low reliability despite high levels of agreement between raters. Prevalence-adjusted kappa values should be presented with Cohen's kappa values in order to evaluate inter-rater agreement when the majority of patients receive recommended care.
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