The 130th Annual Meeting of APHA

Abstract #40337

Christine Goldberg, PhD and Elizabeth Davis, MA. Southwest Catholic Health Network, 2800 North Central, Suite 400, Phoenix, AZ 85004, 602-263-3865, cgoldberg@schn.net

With the expansion of managed healthcare delivery systems, there have been increasing efforts to ensure the reliability of the decisions made by professionals responsible for utilization and administrative decision-making. There seems to be little consensus, however, on the most effective way to monitor reliability.

This presentation describes a comprehensible model that has been used successfully to conduct inter-reviewer reliability (IRR) assessments of various healthcare professionals, including utilization management nurses, case managers, and physician reviewers. The matrix model employs simulated case scenarios to assess knowledge that is essential to effective decision-making. Results are recorded in a matrix format that facilitates analysis of responses by topic, case and participant.

The model was recently used to assess reliability among 40 health care professionals who provide case management services. A presentation of the process and outcomes of this assessment will serve to illustrate the value of a model that identifies ongoing staff development needs, promotes improved communication between staff, and leads to positive program changes.

Learning Objectives:

• Describe the role of inter-reviewer reliability assessment in healthcare staff development.
• Explain the assessment model and the methodology introduced in the presentation.
• Apply the model to a variety of settings and organizational functions.

Keywords: Managed Care, Assessments

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.