Content coding for contextualization of care: evaluating physician performance at patient-centered decision making.

Abstract

BACKGROUND AND OBJECTIVE . Adapting best evidence to the care of the individual patient has been characterized as "contextualizing care" or "patient-centered decision making" (PCDM). PCDM incorporates clinically relevant, patient-specific circumstances and behaviors, that is, the patient's context, into formulating a contextually appropriate plan of care. The objective was to develop a method for analyzing physician-patient interactions to ascertain whether decision making is patient centered. METHODS . Patients carried concealed audio recorders during encounters with their physicians. Recordings and medical records were reviewed for clues that contextual factors, such as an inability to pay for a medication or competing responsibilities, might undermine an otherwise appropriate care plan, rendering it ineffective. Iteratively, the team refined a coding process to achieve high interrater agreement in determining (a) whether the clinician explored the clues-termed "contextual red flags"-for possible underlying contextual factors affecting care, (b) whether the presence of contextual factors was confirmed and, if so, (c) whether they were addressed in the final care plan. RESULTS . A medical record data extraction instrument was developed to identify contextual red flags such as missed appointments or loss of control of a treatable chronic condition which signal that contextual factors may be affecting care. Interrater agreement (Cohen's kappa) for coding whether the clinician explored contextual red flags, whether a contextual factor was identified, and whether the factors were addressed in the care plan was 88% (0.76, P < 0.001), 94% (0.88, P < 0.001), and 85% (0.69, P < 0.001) respectively. CONCLUSIONS . PCDM can be assessed with high interrater agreement using a protocol that examines whether essential contextual information (when present) is addressed in the plan of care.

DOI: 10.1177/0272989X13493146

Cite this paper

@article{Weiner2014ContentCF, title={Content coding for contextualization of care: evaluating physician performance at patient-centered decision making.}, author={Saul J. Weiner and Brendan C. Kelly and N. Ashley and Amy E Binns-Calvey and Gunjan Sharma and Alan Schwartz and Frances M. Weaver}, journal={Medical decision making : an international journal of the Society for Medical Decision Making}, year={2014}, volume={34 1}, pages={97-106} }