Decision Guides Research Articles

Evaluation of Reference Urinary Excretion Concentrations of Selected Radionuclides Corresponding to Clinical Decision Guides for Application in Radiological and in Nuclear Emergencies

Radiological or nuclear emergency situations could lead to incorporation of radionuclides by the population. Intakes of radionuclides can be evaluated through measurements of radionuclides present in organs and tissues, or in urinary and/or fecal excretion. In an emergency situation involving a large number of people, the decision to provide medical treatment to an individual will likely be based on a single measurement. For that purpose, the National Council on Radiation Protection and Measurements (NCRP) has presented the Clinical Decision Guide (CDG) quantity, which corresponds to an intake amount of a radionuclide by an individual for which treatment is recommended. However, the NCRP recommends using one-fifth of the CDG for pregnant women and children which could result in an effective or equivalent dose in excess of the dose constraint. Tables of reference urinary excretion concentrations which are associated with an intake of one CDG for inhalation and ingestion intake scenarios of several forms of 60Co, 90Sr, 137Cs, 192Ir, 238Pu, 239Pu and 241Am have been calculated and are presented for the following categories of members of the public: 3 months old, 1 y, 5 y, 10 y, 15 y, adult and pregnant woman.

Development of a decision guide to support the elderly in decision making about location of care: an iterative, user-centered design.

Plain English summaryFor the elderly to get the care and services they need, they may need to make the difficult decision about staying in their home or moving to another home. Many other people may be involved in their care too (friends, family and healthcare providers), and can support them in making the decision. We asked informal caregivers of elderly people to help us develop a decision guide to support them and their loved ones in making this decision. This guide will be used by health providers in home care who are trained to help people make decisions. The guide is in French and English. To design and test this decision guide we involved elderly people, their caregivers and health administrators. We first asked them what they needed for making the decision, and then designed a first version of the guide. Then we asked them to look at it and give feedback, which was used to make the final version. We then used scientific criteria to check its content and the language used. The final decision guide was acceptable to the caregivers, their elderly loved ones, and the health administrators. The guide is currently being evaluated in a large research project with home care teams in the province of Quebec. Background As they grow older, many elderly people are faced with the difficult and preference-sensitive decision about staying in their home or moving to a residence better adapted to their evolving care needs. We aimed to develop an English and French decision aid (DA) for elderly people facing this decision, and to involve end-users in all phases of the development process. Methods A three-cycle design with involvement of end-users in Quebec. End-users were elderly people (n = 4) caregivers of the elderly (n = 5), health administrators involved in home-care service delivery or policy (n = 6) and an interprofessional research team (n = 19). Cycle 1: Decisional needs assessment and development of the first prototype based on existing tools and input from end-users; overview of reviews examining the impact of location of care on elderly people’s health outcomes. Cycle 2: Usability testing with end-users, adaptation of prototype. Cycle 3: Refinement of the prototype with a linguist, graphic designer and end-users. The final prototype underwent readability testing and an International Patient Decision Aids (IPDAS) criteria compatibility assessment to verify minimal requirements for decision aids and was tested for usability by the elderly. Results Cycle 1: We used the Ottawa Personal Decision Guide to design a first prototype. As the overview of reviews did not find definitive evidence regarding optimal locations of care for elderly people, we were not able to add evidence-based advantages and disadvantages to the guide. Cycle 2: Overall, the caregivers and health administrators who evaluated the prototype (n = 10) were positive. In response to their suggestions, we deleted some elements (overview of pros, cons, and consequences of the options) that were necessary to qualify the tool as a DA and renamed it a “decision guide”. Cycle 3: We developed French and English versions of the guide, readable at a primary school level. The elderly judged the guide as acceptable. Conclusion We developed a decision guide to support elderly people and their caregivers in decision making about location of care. This paper is one of few to report on a fully collaborative approach to decision guide development that involves end-users at every stage (caregivers and health administrators early on, the frail elderly in the final stages). The guide is currently being evaluated in a cluster randomized trial. Trial registration: NCT02244359.

Decision Guide Helps Families Navigate Path From Home to Hospitalization

Decision Guide Helps Families Navigate Path From Home to Hospitalization

ABCs of Diversifying Information Resources among Rice Smallholders of Ghana

Purpose: We investigated how information resource diversification can enhance smallholder agricultural knowledge in Ghana.Design/Methodology/Approach: Study tools and methods were questionnaire survey (N = 200), focus group discussion (N = 1), in-depth interviews (N = 18) and field direct observation.Findings: This study shows there existed diversity of information resources in Hohoe. This diversity was, however, devoid of a broad integration process to enhance smallholder access to and use of agricultural information. We demonstrate that new information channels or sources cannot function independently, but rather through an integrated approach that relies on a human facet of extension.Practical Implications: We illustrate the need for integrated extension that includes interactive field modules such as basic cell phone decision guides that support smallholder construction of solutions for their circumstances. This process requires new sets of smallholder skills and holistic extension schemes that diversify information resources through incorporation and adaptation, rather than substitution. New information resources can only be gradually mainstreamed through integration with more familiar extension means. They need a human interface because smallholder householders did not require same types and/or amounts of information. Human interface is essential to ensure critical groups including women access and utilise agricultural information resources, but without entrenching unfair task allocations among smallholder householders.Originality/Value: This paper illustrates how extension can be strengthened through new approaches. However, new approaches such as use of basic cell phones cannot be standalone processes; they require a human interface and an integrated process. The article presents actual data collected from the Ghana.

Decision coaching using the Ottawa family decision guide with parents and their children: a field testing study.

BackgroundAlthough children can benefit from being included in health decisions, little is known about effective interventions to support their involvement. The objective of this study was to evaluate the feasibility and acceptability of decision coaching guided by the Ottawa Family Decision Guide with children and parents considering insulin delivery options for type 1 diabetes (insulin pump, multiple daily injections, or standard insulin injections).MethodsPre-/post-test field testing design. Eligible participants were children (≤18 years) with type 1 diabetes and their parents attending an ambulatory diabetes clinic in a tertiary children’s hospital. Parent–child dyads received decision coaching using the Ottawa Family Decision Guide that was pre-populated with evidence on insulin delivery options, benefits, and harms. Primary outcomes were feasibility of recruitment and data collection, and parent and child acceptability of the intervention.ResultsOf 16 families invited to participate, 12 agreed and 7 attended the decision coaching session. For the five missed families, two families were unable to attend the session or the decision coach was not available (N=3). Baseline and immediately post-coaching questionnaires were all completed and follow-up questionnaires two weeks post-coaching were missing from one parent–child dyad. Missing questionnaire items were 5 of 340 items for children (1.5%) and 1 of 429 for parents (0.2%). Decision coaching was rated as acceptable with higher scores from parents and their children who were in earlier stages of decision making.ConclusionDecision coaching with children and their parents considering insulin options was feasible implement and evaluate in our diabetes clinic and was acceptable to participants. Recruitment was difficult due to scheduling restrictions related to the timing of the study. Coaching should target participants earlier in the decision making process and be scheduled at times that are convenient for families and coaches. Findings were used to inform a full-scale evaluation that is currently underway.

Cultural adaptation of a shared decision making tool with Aboriginal women: a qualitative study.

BackgroundShared decision making (SDM) may narrow health equity gaps experienced by Aboriginal women. SDM tools such as patient decision aids can facilitate SDM between the client and health care providers; SDM tools for use in Western health care settings have not yet been developed for and with Aboriginal populations. This study describes the adaptation and usability testing of a SDM tool, the Ottawa Personal Decision Guide (OPDG), to support decision making by Aboriginal women.MethodsAn interpretive descriptive qualitative study was structured by the Ottawa Decision Support Framework and used a postcolonial theoretical lens. An advisory group was established with representation from the Aboriginal community and used a mutually agreed-upon ethical framework. Eligible participants were Aboriginal women at Minwaashin Lodge. First, the OPDG was discussed in focus groups using a semi-structured interview guide. Then, individual usability interviews were conducted using a semi-structured interview guide with decision coaching. Iterative adaptations to the OPDG were made during focus groups and usability interviews until saturation was reached. Transcripts were coded using thematic analysis and themes confirmed in collaboration with an advisory group.ResultsAboriginal women 20 to 60 years of age and self-identifying as First Nations, Métis, or Inuit participated in two focus groups (n = 13) or usability interviews (n = 6). Seven themes were developed that either reflected or affirmed OPDG adaptions: 1) “This paper makes it hard for me to show that I am capable of making decisions”; 2) “I am responsible for my decisions”; 3) “My past and current experiences affect the way I make decisions”; 4) “People need to talk with people”; 5) “I need to fully participate in making my decisions”; 6) “I need to explore my decision in a meaningful way”; 7) “I need respect for my traditional learning and communication style”.ConclusionsAdaptations resulted in a culturally adapted version of the OPDG that better met the needs of Aboriginal women participants and was more accessible with respect to health literacy assumptions. Decision coaching was identified as required to enhance engagement in the decision making process and using the adapted OPDG as a talking guide.

Derivation of a Clinical Decision Guide in the Diagnosis of Cervical Facet Joint Pain

ObjectiveTo derive a clinical decision guide (CDG) to identify patients best suited for cervical diagnostic facet joint blocks. DesignProspective cohort study. SettingPain management center. ParticipantsConsecutive patients with neck pain (N=125) referred to an interventional pain management center were approached to participate. InterventionsSubjects underwent a standardized testing protocol, performed by a physiotherapist, prior to receiving diagnostic facet joint blocks. All subjects received the reference standard diagnostic facet joint block protocol, namely controlled medial branch blocks (MBBs). The physicians performing the MBBs were blinded to the local anesthetic used and findings of the clinical tests. Main Outcome MeasuresMultivariate regression analyses were performed in the derivation of the CDGs. Sensitivity, specificity, positive and negative likelihood ratios, and 95% confidence intervals (CIs) were calculated for the index tests and CDGs. ResultsA CDG involving the findings of the manual spinal examination (MSE), palpation for segmental tenderness (PST), and extension-rotation (ER) test demonstrated a specificity of 84% (95% CI, 77–90) and a positive likelihood ratio of 4.94 (95% CI, 2.8–8.2). Sensitivity of the PST and MSE were 94% (95% CI, 90–98) and 92% (95% CI, 88–97), respectively. Negative findings on the PST were associated with a negative likelihood ratio of .08 (95% CI, .03–.24). ConclusionsMSE, PST, and ER may be useful tests in identifying patients suitable for diagnostic facet joint blocks. Further research is needed to validate the CDGs prior to their routine use in clinical practice.

Capsule Commentary on Michaelidis et al., Cost-Effectiveness of Procalcitonin-Guided Antibiotic Therapy for Outpatient Management of Acute Respiratory Tract Infections in Adults

Antibiotic overuse in ambulatory settings is a major public health concern. Acute respiratory infections are often treated empirically and present challenges to judicious antimicrobial use. Procalcitonin has emerged as a biomarker to discriminate between viral and bacterial respiratory infections, and may add value to standard decision guides.1 Acute respiratory infections are costly, and innovations minimizing drug or utilization costs would hold interest, particularly if cost-effective. One study2 examining antibiotic decision making using procalcitonin algorithms in the ICU found procalcitonin cost-effective when daily antibiotics cost more than $149(CAN), while another reports procalcitonin protocols costing more than usual care, with physician non-adherence to procalcitonin algorithms influencing cost-effectiveness in community acquired pneumonia.3 Michaelidis et al. use a decision model with a health system perspective to estimate willingness-to-pay and costs per antibiotic prescription safely avoided for procalcitonin testing compared to usual care in adults with acute respiratory tract infections treated in outpatient settings.4 Overall, their results show that procalcitonin testing costs more than usual care, but reduces the number of antibiotic prescriptions. However, when including societal costs of antibiotic resistance and requirements for antimicrobial treatment, procalcitonin testing may be cost-effective. Decision makers need to evaluate how well innovations maximize health outcomes within budgetary constraints to allocate resources. Although debate continues about cost-effectiveness thresholds,5 knowledge diffusion, adoption and sustainable change management strategies may confound results when implementing innovative approaches such as procalcitonin testing. Michaelidis et al.’s decision model’s bias towards procalcitonin testing assumes strong uptake of this innovation, and may overestimate availability while also omitting the impact of physician adherence on costs or cost-effectiveness.3 The cost-effectiveness model uses two European clinical trials, which may diminish generalizability. Although this study includes important secondary costs associated with antibiotic resistance, future research could further delineate appropriate antibiotic prescribing, include costs associated with antibiotic-induced adverse events, or compare procalcitonin protocol costs to antibiotic stewardship programs.1 Michaelidis et al.’s study brings important cost-effectiveness information about outpatient procalcitonin testing in patients with acute respiratory infections, suggesting it is cost-effective when accounting for antibiotic resistance, although overestimating access to testing and underestimating physician non-adherence may diminish the benefit.

Response to Commentary on Our Article Titled “Intrarater and Interrater Reliability of Select Clinical Tests in Patients Referred for Diagnostic Facet Joint Blocks in the Cervical Spine”

Dr. Stuart McGill provided an insightful commentary on the issues surrounding the usefulness of reliable clinical tests in the management of patients with spinal pain conditions. In this response, we will address the points raised in the commentary and provide a rationale for the use of reliable tests in the development of clinical decision guides.

The rationale for primary spine care employing biopsychosocial, stratified and diagnosis-based care-pathways at a chiropractic college public clinic: a literature review.

Current management practices for low back pain have led to rising costs without evidence of improvement in the quality of care. Low back pain remains a diagnostic and management challenge for practitioners of many types and is now thought to be a leading global cause of disability. Beyond many published clinical practice guidelines, there are emerging, evidence-based care-pathways including stratification according to the patient's prognosis, classification-based management, diagnosis-based clinical decision guides and biopsychosocial models of care. A proposed solution for successfully addressing low back pain is to train residents at a chiropractic college public clinic to function as primary spine care practitioners, employing evidence-based care-pathways. The rationale for such is described with expected benefits to patient care, improved financial health of medical delivery systems and the training of chiropractors to successfully fill a niche in the healthcare system.

The Use of Rainfall Forecasts as a Decision Guide for Small-scale Farming in Limpopo Province, South Africa

Purpose: New innovative ways of communicating agrometeorological information are needed to help farmers, especially subsistence/small-scale farmers, to cope with the high climate variability experienced in most parts of southern Africa. Design/methodology/approach: The article introduces an early warning system for farmers. It utilizes short messaging system (SMS) to convey weather information and basic agronomic advice to 12 small-scale farmers in Makhado Municipality, Limpopo Province, South Africa. This case study demonstrates the usefulness of incorporating weather information on day-to-day farm management activities. Coded rainfall forecasts for light (0–5mm), medium (5–20mm) and heavy rainfall (>20mm) were distributed three times a week to individual farmers and extension officers. Accompanying the forecasts were possible agricultural activities for the week. Findings: Extensive training of the farmers and extension officers is a pre-requisite for full comprehension of the coded SMS early warning system. The recommendations on farming conditions are not always adhered to due to farmers' indigenous knowledge and other factors like access to labour. Practical implications: Weather and climate information distributed to farmers has the potential to add value to the farming methods employed, hence positively impacting on rural food security. Originality/value: The article demonstrates that agrometeorological information must be packaged in such a way as to assist farmers and should be disseminated timeously and appropriately to maximize its utility or adoption.

26A. An Integrative, Evidence-based Algorithm for Spine-related Pain Disorders

Focus Areas: Integrative Approaches to Care, Alleviating PainCurrent management practices for low back pain have led to rising costs without evidence of improvement in the quality of care. Low back pain remains a diagnostic and management challenge for practitioners of many types and is now thought to be a leading global cause of disability. Beyond many published clinical practice guidelines, there are emerging evidence-based care-pathways including stratification according to the patient's prognosis, classification-based management, diagnosis-based clinical decision guides, and biopsychosocial models of care. A proposed solution for successfully addressing low back pain is to employ a novel, integrative, biopsychosocial, stratified, and diagnosis-based care pathway, currently in use at a complementary, integrative healthcare university's clinic. The rationale for the development and implementation is described, including a comparison to related models currently in place at other locations. Benefits of this approach include improved patient outcomes, a more effective and efficient medical delivery system, and creation of a sustainable business model for practitioners. Two case studies are incorporated in the session to illustrate the principles of the integrative model.

Shared decision-making and health for First Nations, Métis and Inuit women: a study protocol.

BackgroundLittle is known about shared decision-making (SDM) with Métis, First Nations and Inuit women (“Aboriginal women”). SDM is a collaborative process that engages health care professional(s) and the client in making health decisions and is fundamental for informed consent and patient-centred care. The objective of this study is to explore Aboriginal women’s health and social decision-making needs and to engage Aboriginal women in culturally adapting an SDM approach.MethodsUsing participatory research principles and guided by a postcolonial theoretical lens, the proposed mixed methods research will involve three phases. Phase I is an international systematic review of the effectiveness of interventions for Aboriginal peoples’ health decision-making. Developed following dialogue with key stakeholders, proposed methods are guided by the Cochrane handbook and include a comprehensive search, screening by two independent researchers, and synthesis of findings. Phases II and III will be conducted in collaboration with Minwaashin Lodge and engage an urban Aboriginal community of women in an interpretive descriptive qualitative study. In Phase II, 10 to 13 Aboriginal women will be interviewed to explore their health/social decision-making experiences. The interview guide is based on the Ottawa Decision Support Framework and previous decisional needs assessments, and as appropriate may be adapted to findings from the systematic review. Digitally-recorded interviews will be transcribed verbatim and analyzed inductively to identify participant decision-making approaches and needs when making health/social decisions. In Phase III, there will be cultural adaptation of an SDM facilitation tool, the Ottawa Personal Decision Guide, by two focus groups consisting of five to seven Aboriginal women. The culturally adapted guide will undergo usability testing through individual interviews with five to six women who are about to make a health/social decision. Focus groups and individual interviews will be digitally-recorded, transcribed verbatim, and analyzed inductively to identify the adaptation required and usability of the adapted decision guide.DiscussionFindings from this research will produce a culturally sensitive intervention to facilitate SDM within a population of urban Aboriginal women, which can subsequently be evaluated to determine impacts on narrowing health/social decision-making inequities.

Modelling the probability of Australian grassfires escaping initial attack to aid deployment decisions

Most grassfires that occur in southern Australia are contained to small areas by local suppression resources. Those that are not require extra resources from neighbouring districts. Identifying these fires at the start of initial attack can prompt early resource requests so that resources arrive earlier when they can more effectively assist with containment. This study uses operational data collected from Australian grassfires that used ground tankers and aircraft for suppression. Variables were limited to those available when the first situation report is provided to incident controllers and included weather parameters, resource response times, slope, curing state, pasture condition and estimated fire area at initial attack. Logistic regression and classification trees were used to identify grassfires likely to escape initial attack by (a) becoming large (final area ≥100 ha), (b) being of long duration (containment time ≥4 h) or (c) either or both of these. These fires would benefit from having more resources deployed to them than are normally available. The best models used initial fire area and Grassland Fire Danger Index as predictor variables. Preliminary operational decision guides developed from classification trees could be used by fire managers to make quick assessments of the need for extra resources at early stages of a fire.

The Mayo Clinic Breast Cancer Book: A New Resource for Patients Navigating Breast Cancer

The Mayo Clinic Breast Cancer Book is a trusted resourcedesignedtohelp patientsandtheirfamilies betterunderstandthedisease,makeinformeddecisionsregardingtheircare,andcopewith the emotional and physical effects of diagnosis andtreatment.The book is designed to demystify breast cancer and givepatients step-by-stepguidanceand tools for whattodoiftheyare at risk or have a diagnosis of breast cancer. The book’smedical co-editors are renowned experts Charles L. Loprinzi,M.D., a breast cancer and oncology specialist and Lynn C.Hartmann, M.D., a breast oncologist and researcher—bothfrom the Mayo Clinic Cancer Center.Using helpful graphics to convey cutting-edge medicalinformation, The Mayo Clinic Breast Cancer Book addressesnumerous questions about breast cancer, including:& Understanding your personal and family risk for breastcancer& How to interpret your biopsy report& Understanding treatment options& Updates on the latest research findings& Living with breast cancer and long-term survivorshipWeaving in personal stories from breast cancer patientsand survivors, The Mayo Clinic Breast Cancer Book isorganized into three parts:& Part 1 includes an overview of cancer in general: What itis, how it develops, and how it spreads.& Part 2 looks specifically at breast cancer and provides acomprehensive discussion of the disease, from risk andprevention to the latest technologies in diagnosis andtreatment. Included in this section are decision guides tohelp determine the best treatment option based on indi-vidual circumstances.& Part 3 focuses on strategies for dealing with the emo-tional, social, spiritual, and physical challenges thataccompany cancer treatment and survival.The Mayo Clinic Breast Cancer Book ($22.95/soft cover,432 pages) is currently available wherever books are sold,beginning on October 1, 2012. Mayo Clinic’s proceeds fromthe book will support medical education and research atMayo.Charles L. Loprinzi, M.D., is a medical oncologist andthe Regis Professor in Breast Cancer Research at MayoClinic Cancer Center, Rochester, MN, USA. He is a pastchair of the Division of Medical Oncology at Mayo Clinic.Dr. Loprinzi has authored more than 350 scientific publica-tions. His primary areas of research involve doctor–patientcommunication and the control of cancer-related symptoms.Dr. Loprinzi is also a recipient of two Susan G. KomenFoundation awards: the Brinker International Award andKomen Foundation Professor of Survivorship Award.Lynn C. Hartmann, M.D., is a medical oncologist and theBlanche R. and Richard J. Erlanger Professor of MedicalResearch at Mayo Clinic Cancer Center, Rochester, MN,USA. Dr. Hartmann led the effort to develop a Women’sCancer Program at Mayo Clinic to advance the scientificunderstanding of breast and gynecologic cancers and toeducate professionals, patients, and the public about thesecancers. With funding from the National Cancer Institute,Department of Defense, American Cancer Society, and theSusan G. Komen Foundation, Dr. Hartmann has authoredmore than 200 research articles. Her focus is on the identi-fication and management of women at high risk of breastcancer.

Using preappraised evidence sources to guide practice decisions

The purpose of this article is two-fold. The first is to describe preappraised evidence sources or a top-down approach to obtaining the best available evidence. The second purpose of the article is to describe how to incorporate preappraised evidence into clinical decision making with the Best Practice Decision Guide. The Best Practice Decision Guide begins with a query of preappraised and filtered electronic sources to obtain recommended evidence summaries, or a so-called "top-down" approach to obtaining the best available evidence. Information on the major issues and dilemmas encountered at each step is presented, including evaluation of clinical practice guidelines and the consideration of relevant studies to particular patients or subpopulations. Recommendations for other resources to use in the appraisal process and in making final practice decision are also described in the article.

VBAC or elective caesarean? a midwife-led shared decision making approach to choice following a caesarean section

BackgroundWomen with one prior caesarean face a choice between an attempted vaginal birth after caesarean (VBAC) or a caesarean section (CS). There is no evidence that either choice is associated...

The synergistic effects of IT-enabled resources on organizational capabilities and firm performance

Computing the value of IT investments and clarifying how the portfolio of IT/IS resources affect a firm's performance and sustainable competitive advantage are critical issues today. We attempted to develop an effective measurement technique and use organizational theory to discover the strategic role of IT-enabled resources in the firm's competitive agenda. Based on a resource-based view of the firm, we proposed a way to evaluate the synergistic effect of such resources on the firm's capabilities, as they, influence the firms’ strategic objectives and improve its financial performance. The technological, human, and organizational resources work together to generate sub-additive cost and super-additive value synergies. Operations, R&D, and marketing capabilities allow firms to implement a business strategy that reflects its customer needs. A survey was conducted to check our framework. Our findings should provide valuable decision guides for practitioners when choosing a portfolio of IT/IS resources for implementing business strategies.

Study Provides Support for Proposed Diagnosis-Based Clinical Decision Guide For Neck Pain

Ms. Hoffmeister is a freelance medical writer in Camp Hill, Pennsylvania. The author and all staff in a position to control the content of this CME activity have disclosed that they and their spouses/life partners (if any) have no financial relationships with, or financial interests in, any commercial companies pertaining to this educational activity. To earn CME credit, you must read the CME articles and complete the quiz and evaluation assessment survey on the enclosed form, answering at least 70% of the quiz questions correctly. This continuing medical enduring material activity expires December 31, 2012. Lippincott Continuing Medical Education Institute, Inc., is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. Lippincott Continuing Medical Education Institute, Inc., designates this enduring material for a maximum of 1.5 AMA PRA Category 1 Credits™. Physicians should claim only credit commensurate with the extent of their participation in the activity. Lippincott's Bone and Joint Newsletter is an independent publication solely owned and published by Lippincott Williams & Wilkins and has no affiliation with the Journal of Bone & Joint Surgery.

Seven reliability indices for high‐stakes decision making: Description, selection, and simple calculation

AbstractThe reliability of data is a critical issue in decision‐making for practitioners in the school. Percent Agreement and Cohen's kappa are the two most widely reported indices of inter‐rater reliability, however, a recent Monte Carlo study on the reliability of multi‐category scales found other indices to be more trustworthy given the type of data and number of categories. This manuscript presents defensible decision steps, methods, and rationale for selecting and calculating inter‐rater reliability for practitioners. In addition to using screen shots from readily available online programs for calculation such as Excel and Vassar College (Lowry, 2010), decision guides and a flow chart are presented in several figures and tables for easy reference. © 2011 Wiley Periodicals, Inc.