Holistic Admission Research Articles

A Proposal for Evaluating the Validity of Holistic-Based Admission Processes

Background. Admission decisions require that information about an applicant be combined using either holistic (human judges) or statistical (actuarial) methods. For optimizing a defined measureable outcome, there is a consistent body of research evidence demonstrating that statistical methods yield superior decisions compared to those generated by judges. It is possible, however, that the benefits of holistic decisions are reflected in unmeasured outcomes. If such benefits exist, they would necessarily appear as systematic variance in raters’ scores that deviate from statistically-based decisions. Purpose. To estimate this variance, we propose a design examining the interrater reliability of difference scores (i.e., the difference between observed committee rankings and rankings based on statistical approaches). Methods. Example calculations and G study models are presented to demonstrate how rater agreement on difference scores can be analyzed under various circumstances. High interrater reliability of difference scores would support but not prove the assertion that the holistic process adds useful information beyond that achieved by much less costly statistical approaches. Conversely, if the interrater reliability of difference scores is near zero, this would clearly demonstrate that committee judgments add random error to the decision process. Results. Evidence to conduct such studies already exists within most highly selective medical schools and graduate programs and the proposed validity research could be conducted on existing data. Conclusions. Such research evidence is critical for establishing the validity of widely used holistic admission approaches.

Development of a holistic admission assessment: an integrated care pathway for the hospice setting

This article describes the development of a holistic admission assessment for all inpatients admitted to a 66-bedded hospice, structured in the form of an integrated care pathway (ICP). The need for an improved assessment process was identified by clinical staff, who recognized that the existing assessment was not truly holistic and was dependent on the skills of the assessors. The assessment also lacked appropriate goals and actions. The recently published National Institute for Clinical Excellence (NICE) guidance on Improving Supportive and Palliative Care for Adults with Cancer, has also highlighted key areas for the improvement of patient assessment in specialist palliative care (NICE, 2004). Implementation of the ICP has resulted in a systematic and timely holistic assessment process for patients. The ICP addresses effectively the NICE recommendations for the assessment of specialist palliative care patients.