RESUMEN
INTRODUCTION: An electronic patient record (EPR) with disease-specific data may support improvement of the quality of care for patients with chronic diseases. The structure and content of such a record can only be assessed by clinicians in co-operation with IT-specialists, because, the result has to be clinically relevant, easily accessible and adjusted to the information needs of different workers in primary care. METHODS: We applied a modified Delphi-procedure--a method characterized by anonymous written comments by an expert panel. The panel had to agree about the question whether or not an item should be included in the EPR. The questions for the written comments were prepared by a steering committee (general practitioners (GP) and health scientists, either expert in asthma and disease management or IT-specialist) based on the guidelines for diagnosing and treating asthma of the Dutch College of General Practitioners (DCGP). When agreement within the panel was < or = 70%, we sent a modified format to the expert panel for reassessment. RESULTS: Three written commentary rounds were necessary, in which 95 potential items were discussed with the expert panel. In the first round they selected 50 items relating to diagnosing asthma and 22 concerning the treatment of asthma. During the second round 17 items were still under discussion and six were rejected. In subsequent rounds, the expert-panel assessed the best registration format (operationalisation). The written rounds failed to create a full consensus. Therefore the study ended with a consensus meeting of the expert panel. Due to the presence and contribution of nearly all experts, consensus could be reached about the structure and contents of the EPR on asthma. DISCUSSION: The modified Delphi procedure, proved to be a feasible method for selecting the optimal content of an electronic registration protocol. Both, written and verbal commentary rounds were necessary. The existence of a set of guidelines was essential.
Asunto(s)
Asma/terapia , Técnica Delphi , Sistemas de Registros Médicos Computarizados , Manejo de la Enfermedad , Humanos , Garantía de la Calidad de Atención de SaludRESUMEN
OBJECTIVES: To assess the reliability of a classification scheme and interview questions to be used for retrospective expose assessment in a study on reproductive disorders among hairdressers. Based on the presence of an air cleaning device (yes or no) and setting waves (yes or no), this scheme divides hairdressers into groups with potentially high and low exposure to solvents. The reliability of this and other schemes was assessed. Also; the reliability of self reports on other job characteristics was evaluated. METHODS: The monitored hairdressers were interviewed one or two years after measurements were performed. Based on the interview information, hairdressers were classified into exposure groups according to the original and other classification schemes. Measured ethanol concentrations were compared between the classified exposure groups. Furthermore, the interview answers were compared with the registered information one to two years ago. RESULTS: Using self reports, the original scheme resulted in mean ethanol concentrations (used as indicator variable) of 11.8 and 7.4 mg/m3 for the high and low exposure groups, respectively. The resolution was slightly less than for the original classification based on observations (15.0 and 7.1 mg/m3). Surprisingly, the self reported presence of any ventilation device resulted in more contrast in mean exposure concentration between the groups (17.4 and 7.5 mg/m3, respectively). Hairdressers reported validly on salon characteristics such as the type of salon, the number of hairdressers that worked in the salon, and the presence of ventilation devices, but could not make a distinction between different kinds of ventilation devices. The numbers of customers and tasks performed were largely overreported, but most variables correlated significantly with the information registered during the measurements. CONCLUSION: The self reported presence of any ventilation device is most predictive for the level of exposure to ethanol in the hairdressing salon. Questionnaire data on work characteristics should be treated with caution.