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Development of a measure of decision quality for implantable defibrillators
Author(s) -
Knoepke Christopher E.,
Allen Larry A.,
Sepucha Karen,
Masoudi Frederick A.,
Kutner Jean,
Varosy Paul,
Magid David,
Matlock Daniel D.
Publication year - 2021
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/pace.14189
Subject(s) - medicine , discriminant validity , reimbursement , reliability (semiconductor) , scale (ratio) , content validity , cohort , implantable cardioverter defibrillator , quality (philosophy) , psychometrics , clinical psychology , internal consistency , health care , power (physics) , physics , quantum mechanics , economics , philosophy , epistemology , economic growth
Abstract Background CMS reimbursement guidelines for implantable cardioverter‐defibrillators (ICDs) include mandated shared decision making (SDM), but without any manner of assessing the quality of decisions made. We developed and tested a scale meant to assess patients’ knowledge of and preferences specific to ICDs. Such a tool would assess these constructs in the clinical environment, targeting resources and support for patients considering a primary prevention ICD. Methods Development of the ICD decision quality (ICD‐DQ) scale included (1) item creation, (2) content validation using surveys of patients ( n = 23) and clinicians ( n = 31), and (3) examination of validity and reliability using a survey of patients who previously received an ICD ( n = 295, response rate = 72%). Results The final scale consists of 12 knowledge and 8 preference items. With respect to content validity, clinician and patient respondents agreed on the importance of 19 of 24 candidate knowledge items (79%), and 9 of 11 treatment preference items (81%). Knowledge items exhibited moderate internal validity (α = 0.62, 1 factor), strong test‐retest reliability (mean % correct at first administration = 59%, 62% at follow‐up, P > .1) and discriminant validity (59% correct for patients, 93% among cardiologists). Short versions of the ICD‐DQ were developed for clinical settings, the scores from both of which correlated with the long version in this cohort (11‐item ( r = 0.90) and a 5‐item ( r = 0.75)). Conclusions : The ICD‐DQ fills a critical gap in measuring the quality of patients’ ICD decisions. They may be used to evaluate the effectiveness of patient decision aids or the quality of SDM in clinical practice.