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Looking Inside the Black Box of Comprehensive Geriatric Assessment: A Classification System for Problems, Recommendations, and Implementation Strategies
Author(s) -
Reuben David B.,
Fishman Linda K.,
McNabney Matthew,
WoldeTsadik Girma
Publication year - 1996
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.1996.tb03744.x
Subject(s) - medicine , coding (social sciences) , geriatrics , reliability (semiconductor) , gerontology , health care , family medicine , psychiatry , power (physics) , statistics , physics , mathematics , quantum mechanics , economics , economic growth
OBJECTIVE: To develop and test the inter‐rater reliability of a coding system for geriatric problems identified through Comprehensive Geriatric Assessment (CGA) of hospitalized older persons, recommendations generated by the assessment, and implementation strategies for these recommendations. DESIGN: Validation study. SETTING: A health maintenance organization and a geriatrics academic program. PARTICIPANTS: A total of 49 hospitalized older persons, who met at least 1 of 13 inclusionary “targeting” criteria, two geriatricians, and one social worker who coded forms. MEASUREMENTS: Standardized coding of CGA consultation sheets into (1) geriatric problems identified, (2) recommendations, and (3) implementation strategies; inter‐rater reliability testing of coding system using two physicians and a social worker. RESULTS: On average, each assessed patient had 4.8 recommendations. The largest percentages of recommendations were for non‐physician referrals (18.2%), advance directives (13.4%), medication adjustments (11.5%), diagnostic evaluation/monitoring (11.5%), and community services (10.9%). The proportions of agreement between raters in coding problems ranged from 0.77 to 0.90, in coding recommendations from 0.69 to 0.86, and in coding implementation strategies from 0.68 to 0.83. CONCLUSION: A classification system for measuring some components of the process of care of CGA has satisfactory inter‐rater reliability, can be adapted for other settings, and may provide valuable insight into determining which components of CGA confer health benefits.