A prospective study assessing agreement and reliability of a geriatric evaluation

BMC Geriatrics

Research Article

Jacques Cornuz¹  Isabella Locatelli²  Nicolas Senn³  Stéfanie Monod⁴  Christophe J. Büla⁵ 

[1] Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland;Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland;Institute of Social and Preventive Medicine, University of Lausanne, Lausanne, Switzerland;Institute of family medicine, Department of ambulatory care and community medicine, University of Lausanne, Lausanne, Switzerland;Public Health Office, Canton de Vaud, Lausanne, Switzerland;Service of Geriatric Medicine & Geriatric Rehabilitation, University of Lausanne Hospital Center, Lausanne, Switzerland;

关键词: Geriatric consultation;    Reliability;    Agreement;    Kappa index;    Intraclass correlation coefficient;   

DOI  :  10.1186/s12877-017-0546-9

 received in 2017-02-23, accepted in 2017-07-11,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundThe present study takes place within a geriatric program, aiming at improving the diagnosis and management of geriatric syndromes in primary care. Within this program it was of prime importance to be able to rely on a robust and reproducible geriatric consultation to use as a gold standard for evaluating a primary care brief assessment tool. The specific objective of the present study was thus assessing the agreement and reliability of a comprehensive geriatric consultation.MethodThe study was conducted at the outpatient clinic of the Service of Geriatric Medicine, University of Lausanne, Switzerland. All community-dwelling older persons aged 70 years and above were eligible. Patients were excluded if they hadn’t a primary care physician, they were unable to speak French, or they were already assessed by a geriatrician within the last 12 months. A set of 9 geriatricians evaluated 20 patients. Each patient was assessed twice within a 2-month delay. Geriatric consultations were based on a structured evaluation process, leading to rating the following geriatric conditions: functional, cognitive, visual, and hearing impairment, mood disorders, risk of fall, osteoporosis, malnutrition, and urinary incontinence. Reliability and agreement estimates on each of these items were obtained using a three-way Intraclass Correlation and a three-way Observed Disagreement index. The latter allowed a decomposition of overall disagreement into disagreements due to each source of error variability (visit, rater and random).ResultsAgreement ranged between 0.62 and 0.85. For most domains, geriatrician-related error variability explained an important proportion of disagreement. Reliability ranged between 0 and 0.8. It was poor/moderate for visual impairment, malnutrition and risk of fall, and good/excellent for functional/cognitive/hearing impairment, osteoporosis, incontinence and mood disorders.ConclusionsSix out of nine items of the geriatric consultation described in this study (functional/cognitive/hearing impairment, osteoporosis, incontinence and mood disorders) present a good to excellent reliability and can safely be used as a reference (gold standard) to evaluate the diagnostic performance of a primary care brief assessment tool. More objective/significant measures are needed to improve reliability of malnutrition, visual impairment, and risk of fall assessment before they can serve as a safe gold standard of a primary care tool.

【 授权许可】

CC BY   
© The Author(s). 2017