Implicit Review Instrument to Evaluate Quality of Care Delivered by Physicians to Children in Emergency Departments

Objective: To evaluate the consistency, reliability, and validity of an implicit review instrument that measures the quality of care provided to children in the emergency department (ED). Data Sources/Study Setting: Medical records of randomly selected children from 12 EDs in the Pediatric Emergency Care Applied Research Network (PECARN). Study Design: Eight pediatric emergency medicine physicians applied the instrument to 620 medical records. Data Collection/Extraction Methods: We determined internal consistency using Cronbach's alpha and inter-rater reliability using the intraclass correlation coefficient (ICC). We evaluated the validity of the instrument by correlating scores with four condition-specific explicit review instruments. Principal Findings: Individual reviewers' Cronbach's alpha had a mean of 0.85 with a range of 0.76–0.97; overall Cronbach's alpha was 0.90. The ICC was 0.49 for the summary score with a range from 0.40 to 0.46. Correlations between the quality of care score and the four condition-specific explicit review scores ranged from 0.24 to 0.38. Conclusions: The quality of care instrument demonstrated good internal consistency, moderate inter-rater reliability, high inter-rater agreement, and evidence supporting validity. The instrument could be useful for systems' assessment and research in evaluating the care delivered to children in the ED.