Human services workers: a study of perceptions of their role.

Human services workers at the Veterans Administration Hospital, Brentwood, are involved with patients from the time they are admitted to the hospital until they are discharged and adjust to the community. As part of an evaluation of their role, a study was done of their tasks as perceived by themselves, by their supervisors, by other paraprofessionals, and by patients. In general, human services workers were perceived to be most involved in assisting patients in the hospital, followed by involvement in treatment planning; discharge; therapy; assisting patients in the community; support activities; community activities; patient admission and evaluation; and research, education, and program evaluation.

Approaches to reliability in a clinical simulation study.

Discusses the reliability of measurements made by 48 raters who used the Problem Dysfunction Rating Scale (PDRS) under simulated routine clinical record-keeping conditions. Ten- to 15-minute videotape interviews of two simulated patients with predefined problems were shown to a multidisciplinary psychiatric hospital staff of varying educational background and clinical experience. These raters were given only brief instructions and no training in the use of the PDRS. Statistical analysis included application of the usual, traditional test and retest variation studies and used variance components and comparison to random rating models. A random contrast of rater agreement was found to index most realistically reliability in instances such as this, in which a large number of raters rate a small number of items. There was greater intrarater consistency than interrater agreement, and it was concluded that when reasonably adequate information was available the degree of dysfunction due to patients' problems could be rated on the PDRS with a useful degree of consistency by untrained raters.

Improving patient care through measurement: goal importance and achievement scaling.

Sophisticated treatment record keeping requires something more than a focus on problems. An emphasis on positive aspects of treatment, i.e., on goals may be more appropriate for certain patients or for certain types of treatment or at specific stages of an illness. Unfortunately, currently available methods of quantifying goal importance and achievement are not entirely satisfactory for general everday use. GIA is proposed as a simple procedure for quantifying judgments of the importance of a treatment goal, of the extent to which that goal is achieved and of determining the social value of what treatment has accomplished. GIA ratings have considerable potential for improving patient care through measurement.

A simple approach to interrater agreement.

We have described a simple method for computing a measure of interrater agreement or reliability. This method depends on an experimental design that uses a consensus rating as well as individual ratings. The computations required are counting and percentages; the overall agreement index uses a simple weighting average.