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Meeting ReportResearch methodology and instrument development

Inter-Rater Reliability of Coding of Clinician Communication within a Randomized Trial to Reduce Low-Value Spinal Imaging

Carly Robinson, Melissa Gosdin, Camille Cipri, Gary Weinberg and Joshua Fenton
The Annals of Family Medicine January 2023, 21 (Supplement 1) 4303; DOI: https://doi.org/10.1370/afm.21.s1.4303
Carly Robinson
BS
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Melissa Gosdin
PhD
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Camille Cipri
BS
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Gary Weinberg
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Joshua Fenton
MD, MPH
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Abstract

Context: Back pain is one of the most common reasons for primary care visits and is followed by low- value spinal imaging in a high proportion of visits. A watchful waiting (WW) approach involves following a conservative treatment plan while negotiating a waiting period prior to pursuing imaging. This study is part of a randomized trial of a standardized patient (SP)-delivered intervention to improve clinician communication and increase pursuit of WW during visits with patients with back pain.

Objective: To determine the inter-rater reliability of trained coders in assessment of intra-visit clinician communication behaviors during study visits.

Study Design and Analysis: Study visits with SPs portraying patients with acute back pain were recorded and transcribed. Guided by a coding manual, two coders independently rated targeted communication based on a modification of the Four Habits model.

Setting or Dataset: Primary care and urgent care clinics in Sacramento, CA.

Population Studied: The sample includes 52 primary care clinicians for which coding reliability was assessed on the initial 27 visits.

Intervention/Instrument: Two research assistants were trained and supervised by a medical sociologist using a codebook. SP visit transcripts were coded independently by each blinded research assistant, with disagreement resolved by consensus.

Outcome Measures: Inter-observer agreement for coding of targeted behaviors was assessed using Cohen’s weighted kappa.

Results: Weighted kappa item ratings in the following Four Habits were: 1. Invest in the beginning: 0.62 (95% CI: 0.36-0.88); 2. Elicit the patient’s perspective: 0.71 (0.48-0.94); 3. Demonstrate empathy: 0.60 (0.38-0.82); 4. Invest in the end: 0.68 (0.42-0.94).

Conclusions: Using a modification of the Four Habits model, trained coders achieved moderate to substantial inter-rater reliability when coding for physician communication behaviors related to a watchful waiting approach to reduce low-value imaging for acute back pain.

  • © 2023 Annals of Family Medicine, Inc.
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The Annals of Family Medicine: 21 (Supplement 1)
The Annals of Family Medicine: 21 (Supplement 1)
Vol. 21, Issue Supplement 1
1 Jan 2023
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Inter-Rater Reliability of Coding of Clinician Communication within a Randomized Trial to Reduce Low-Value Spinal Imaging
Carly Robinson, Melissa Gosdin, Camille Cipri, Gary Weinberg, Joshua Fenton
The Annals of Family Medicine Jan 2023, 21 (Supplement 1) 4303; DOI: 10.1370/afm.21.s1.4303

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Inter-Rater Reliability of Coding of Clinician Communication within a Randomized Trial to Reduce Low-Value Spinal Imaging
Carly Robinson, Melissa Gosdin, Camille Cipri, Gary Weinberg, Joshua Fenton
The Annals of Family Medicine Jan 2023, 21 (Supplement 1) 4303; DOI: 10.1370/afm.21.s1.4303
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More in this TOC Section

  • Card studies using EHR alerts linked to REDCap questionnaires: a practical session on how to build the tools
  • Development of a framework for transferring tests evaluated in secondary care to primary care settings: a Delphi study
  • Assessing patient experience through the attitudes and emotions expressed during medical encounters
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