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Results for “Delphi Technique”

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PubMed1998

How well are patients treated in family practice? Quality of consultations for non-acute abdominal complaints.

OBJECTIVE: To describe the application of weighted review criteria, developed by the Delphi technique, for the assessment of the quality of consultations concerning non-acute, abdominal complaints. DESIGN: Descriptive study in two parts: (i) comparison of actual family doctor (FD)-performance with predefined review criteria; (ii) calculation of quality scores per consultation, utilizing the weighted criteria. SETTINGS: Sixty-two family practices across The Netherlands. SUBJECT: Eight-hundred and forty consultations concerning non-acute abdominal complaints, first encounters. MAIN OUTCOME MEASURES: The percentage of consultations in which each criterion was met; quality scores per consultation and their distribution. RESULTS: (i) Little effort was made to trace risk groups for gastrointestinal malignancies (< 50% of the consultations concerned); medication was often described without dietary advice (17%); inappropriate activities were not carried out on a large scale (6%). (ii) Quality scores were normally distributed. CONCLUSIONS: The Delphi technique yields a useful instrument for assessment of the quality of consultations. The review criteria for quality assessment of FD performance used in this study made it possible to distinguish quite clearly between high- and low-quality consultations. Some important deficiencies in daily practice emerged.

Abdomen↗

PubMed2000

Identifying management competencies for health care executives: review of a series of Delphi studies.

This analysis reviews a selected body of research that identifies the essential areas of management expertise required of future health care executives. To ensure consistency, six studies are analyzed, utilizing the Delphi technique, to query a broad spectrum of experts in different fields and sites of health care management. The analysis identifies a number of management competencies, i.e., managerial capabilities, which current and aspiring health care executives, in various settings and with differing educational backgrounds, should possess to enhance the probability of their success in current and future positions of responsibility. In addition, this review identifies the skills (technical expertise), knowledge (facts and principles) and abilities (physical, mental or legal power) required to support achievement of these competencies. Leadership and resource management, including cost and finance dimensions, are the highest-rated requisite management competencies. The dominant skills, knowledge and abilities (SKAs) are related to interpersonal skills. The lowest-rated SKAs are related to job-specific, technical skills. Recommendations include the review of this research by formal and continuing education programs to determine the content of their courses and areas for future research. Similarly, current health care executives should assess this research to assist in identifying competency gaps. Lastly, this analysis recommends that the Delphi technique, as a valid and replicable methodology, be applied toward the study of non-executive health care managers, e.g., students, clinicians, mid-level managers and integrated systems administrators, to determine their requisite management competencies and SKAs.

Delphi Technique↗

PubMed2003

EULAR Recommendations 2003: an evidence based approach to the management of knee osteoarthritis: Report of a Task Force of the Standing Committee for International Clinical Studies Including Therapeutic Trials (ESCISIT).

OBJECTIVES: To update the EULAR recommendations for management of knee osteoarthritis (OA) by an evidence based medicine and expert opinion approach. METHODS: The literature search and guidelines were restricted to treatments for knee OA pertaining to clinical and/or radiological OA of any compartment of the knee. Papers for combined treatment of knee and other types of OA were excluded. Medline and Embase were searched using a combination of subject headings and key words. Searches for those treatments previously investigated were conducted for January 1999 to February 2002 and for those treatments not previously investigated for 1966 to February 2002. The level of evidence found for each treatment was documented. Quality scores were determined for each paper, an effect size comparing the treatment with placebo was calculated, where possible, and a toxicity profile was determined for each treatment modality. RESULTS: 497 new publications were identified by the search. Of these, 103 were intervention trials and included in the overall analysis, and 33 treatment modalities were identified. Previously identified publications which were not exclusively knee OA in the initial analysis were rejected. In total, 545 publications were included. Based on the results of the literature search and expert opinion, 10 recommendations for the treatment of knee OA were devised using a five stage Delphi technique. Based on expert opinion, a further set of 10 items was identified by a five stage Delphi technique as important for future research. CONCLUSION: The updated recommendations support some of the previous propositions published in 2000 but also include modified statements and new propositions. Although a large number of treatment options for knee OA exist, the evidence based format of the EULAR Recommendations continues to identify key clinical questions that currently are unanswered.

Adrenal Cortex Hormones↗

PubMedDate not supplied

Development of a quantitative weighted scoring instrument to evaluate bedside blood glucose testing programs.

The present assessment of laboratory quality is primarily a qualitative summary process. The objective of our study is to convert a qualitative standards document into a quantitative, weighted scoring system. We selected a laboratory testing standards document, Ancillary (Bedside) Blood Glucose Testing in Acute and Chronic Care Facilities, C30, developed by the National Committee for Clinical Laboratory Standards (NCCLS), as our prototype and used a two-stage, modified delphi technique. Sixty-nine criteria were identified from the C30 document. Using a two-stage, modified delphi technique, members of the NCCLS committee that developed the guideline weighted the relative importance of each criteria. This weighting system then was used to evaluate the quality of bedside glucose testing at the 14 general hospitals located within the city limits of Boston.

Blood Glucose↗

PubMedDate not supplied

Delphi survey of priorities in clinical nursing research.

Using the Delphi technique, a panel of 433 nurse and nonnurse experts was surveyed regarding priorities for clinical research in nursing. Of these, 341 completed all four Delphi survey rounds. Three questions were studied: 1) Is this an area in which nursing should assume primary research responsibility? 2) How important is research on this topic for the profession of nursing? 3) What is the likelihood of change in patient welfare because of research on the topic? Although the nature and amount of data produced prohibited interpretation of the data or delineation of succinct conclusions about priorities for clinical nursing research, responses to the three questions supported these statements: The majority of research areas identified in the questionnaire are areas in which nursing should take research leadership. Although there is some overlap, priorities for professional significance and social or patient welfare relevance are different. In terms of professional significance, highest priority was given to items regarding measuring the quality of care, role, nursing process, and the research process. In terms of patient welfare, several programs of research are discernible in the items ranked in the top ten percent; these include nursing interventions related to stress, care of the aged, pain, and patient education. The Delphi technique also is described.

Evaluation Studies as Topic↗

PubMed1995

Financial consequences of reducing treatment availability in a publicly-funded orthodontic service. A decision analysis problem.

When a third party is responsible for funding a component of the health service, cost/benefit assessments become important. Such assessments become urgent when the budget is reduced. In this paper decision analysis has been applied to evaluate potential savings by reducing the proportion of children offered free orthodontic treatment through the National Health Service in Denmark. Data for the development of the decision tree was acquired using the Delphi technique. The results suggest that a reduction in the proportion of children offered early treatment might ultimately lead to an increased consumption of resources. Further investigation of the issue is needed before definitive recommendations can be made.

Budgets↗

PubMed2006

[Personality disorders in the elderly: diagnostic aspects].

This article describes the usefulness of the DSM personality disorders. In conclusion the presence of personality disorders during a lifetime is not always an enduring pattern of (the same) conduct disorders. Despite this, the DSM describes a static course of mainly interpersonal behaviour. Next to this, the utility of the DSM-Axis-II assessment and general personality assessment in relation to older adults will be discussed. In general these instruments are not very suitable for the assessment of the disposition and gravity of personality disorders in the elderly. It is proposed to develop specific profiles with regard to personality disorders in the elderly by applying the Delphi-technique on existing personality assessment. A Delphi panel of experts in the field of personality pathology in older adults can be asked to mention a certain personality disorder and describe this on a certain personality selfreport list, like the shortened version of the TCI.

Aged↗

PubMed2005

Disagreement between formal and medical record criteria for the diagnosis of acute coronary syndrome.

OBJECTIVES: To measure agreement between formal and medical record criteria for the diagnosis of acute coronary syndrome (ACS) among patients undergoing an emergency department evaluation for potential acute coronary symptoms. METHODS: Cases of ACS were determined by both formal (World Health Organization 1984 criteria for acute myocardial infarction [AMI], Braunwald criteria for unstable angina pectoris [UAP]) and medical record criteria. In the latter, a diagnosis was made if providers indicated AMI or UAP anywhere in the medical record. All information included in formal criteria was available to clinicians establishing the medical record diagnosis. The two criteria for diagnosis were compared, and a kappa value was recorded. Two blinded observers adjudicated discordant cases, with a kappa value recorded. Disagreements between these two coinvestigators were resolved by a Delphi technique. RESULTS: A total of 375 eligible subjects were enrolled, of whom 65 (17%; 45 AMI, 20 UAP) had ACS by both sets of criteria. Formal and medical record criteria disagreed in 32 subjects. This represented 9% (95% confidence interval = 6% to 12%) of the overall study population but 33% (95% confidence interval = 23% to 43%) of subjects with possible ACS. Coinvestigators acting as judges and blinded to each other's determinations agreed that 25 of these subjects had ACS and three did not; they disagreed on four subjects (kappa = 0.54). Among these four subjects, a Delphi consensus technique determined that two subjects had AMI and two had no ACS. CONCLUSIONS: In a single-site study, among subjects who have possible ACS as determined by either or both formal and medical record criteria, these two sets of criteria disagree in almost one third of cases. Among discordant cases, even two expert judges frequently disagreed on the final diagnosis. A modified Delphi technique to address these disagreements is described.

Acute Disease↗

PubMed1979

Using Delphi to achieve congruent objectives and activities in a pediatrics department.

This study demonstrated the use of the Delphi technique in conjunction with activity analysis to obtain consensus on and clarity of objectives and activities of full-time members of an academic medical department. The results indicated that the Delphi technique is an effective method not only for obtaining a consensus on objectives but also for elucidating areas where there is no apparent consensus. The results also revealed which activities contributed to the objectives of the department and in which areas there was a divergence of objectives from the actual activities being carried out.

British Columbia↗

PubMed2005

Development of a framework with specific reference to exit-level outcomes for the education and training of South African undergraduate physiotherapy students.

The aim of the study was to develop a framework for undergraduate programmes for the education and training of physiotherapists in South Africa. The research comprised a literature survey, interviews with United Kingdom physiotherapy educators and departmental workshops in South Africa. The Delphi technique was employed as research method to evaluate the proposed framework. The measuring instrument was a questionnaire comprising of amongst others, statements related to exit-level outcomes, which were rated on a five-point rating scale. Two rounds of the Delphi technique were required before acceptable consensus was reached and a framework for the development of a physiotherapy education and training programme was compiled. The framework has been designed as a benchmark for the development of innovative physiotherapy curricula in South Africa. This paper provides information of the exit-level outcomes specified in the framework.

Competency-Based Education↗

PubMedDate not supplied

Preventable drug-related morbidity in older adults 1. Indicator development.

OBJECTIVE: To develop viable clinical indicators of preventable drug-related morbidity (PDRM) in older adults. METHODS: A survey was constructed, listing the clinical outcome and pattern of care related to a number of possible PDRMs in older adults. Using the Delphi technique, a geriatric medicine expert panel of 6 physicians and one clinical pharmacist from a hospital-based health care system was asked to judge whether the outcome in each situation was foreseeable and recognizable, and whether causality was identifiable and controllable. The panel could also suggest additional PDRMs. RESULTS: Fifty-two consensus-approved clinical indicators of PDRM in older adults were developed after 2 rounds of the Delphi technique. There was a high degree of consensus among the expert panel: all 7 members agreed on 35 indicators; 6 of 7 members agreed on 15 indicators; and 5 members agreed on 2 indicators. Only 6 outcomes and patterns of care were rejected as indicators. CONCLUSIONS: This phase of the study showed that consensus on clinical indicators of PDRM can be reached among experts. These indicators could be used by a managed care organization to proactively identify patients at risk for a PDRM and to improve the quality, safety, and appropriateness of medication use. Additionally, the indicators form an important bridge between processes and outcomes of care and could be used in conjunction with HEDIS and other performance indicators.

Journal Article↗

PubMed2004

Important computer competencies for the nursing profession.

Nursing requires computer competencies. This study aimed at identifying those competencies required for the nursing profession in Taiwan. The Delphi technique was deployed in this study. In the Delphi questionnaires, computer competencies were sorted into seven domains: concepts of hardware, software, and networks; principles of computer applications; skills of computer usage; program design; limitations of the computer; personal and social issues; attitudes toward the computer. In three Delphi questionnaires, nursing informatics experts gave us their opinions on the importance of each computer competency for the nursing profession. The experts also designated when the competency should be cultivated. This study provides a comprehensive list for nursing professionals to check on their computer competence. The results of this study should also serve as good references for teachers and schools in designing related curriculums.

Adult↗

PubMed2002

Elicitation of quantitative data from a heterogeneous expert panel: formal process and application in animal health.

This paper presents a protocol for a formal expert judgment process using a heterogeneous expert panel aimed at the quantification of continuous variables. The emphasis is on the process's requirements related to the nature of expertise within the panel, in particular the heterogeneity of both substantive and normative expertise. The process provides the opportunity for interaction among the experts so that they fully understand and agree upon the problem at hand, including qualitative aspects relevant to the variables of interest, prior to the actual quantification task. Individual experts' assessments on the variables of interest, cast in the form of subjective probability density functions, are elicited with a minimal demand for normative expertise. The individual experts' assessments are aggregated into a single probability density function per variable, thereby weighting the experts according to their expertise. Elicitation techniques proposed include the Delphi technique for the qualitative assessment task and the ELI method for the actual quantitative assessment task. Appropriately, the Classical model was used to weight the experts' assessments in order to construct a single distribution per variable. Applying this model, the experts' quality typically was based on their performance on seed variables. An application of the proposed protocol in the broad and multidisciplinary field of animal health is presented. Results of this expert judgment process showed that the proposed protocol in combination with the proposed elicitation and analysis techniques resulted in valid data on the (continuous) variables of interest. In conclusion, the proposed protocol for a formal expert judgment process aimed at the elicitation of quantitative data from a heterogeneous expert panel provided satisfactory results. Hence, this protocol might be useful for expert judgment studies in other broad and/or multidisciplinary fields of interest.

Animal Welfare↗

PubMed1997

Developing strategic plans for academic general internal medicine.

There is an increasing need to train more primary care physicians. Therefore, it would be advantageous for academic general internal medicine (GIM) to develop strategies to meet these demands. Our GIM division developed a strategic planning process with the participant groups being the division faculty, a pertinent literature review (the surrogate expert), and selected medical administrators. The IDEALS systems design provided the conceptual framework for the strategic planning process. This process used the Delphi technique to develop the theoretically ideal work system based on the division's vision for its future role, and the Nominal Group Process Technique to create the recommended work system, using the Delphi results. The strategic planning process was economical and division faculty agreed that it was useful.

Delphi Technique↗

PubMedDate not supplied

It's all in a name. When is a 'Delphi study' not a Delphi study?

As nursing researchers we need to fully understand the origins of the methods we are using in research investigations. Without an in-depth understanding, we may find ourselves violating fundamental underpinning assumptions or conventions through ignorance, and the resulting studies are unlikely to stand up to tests of congruence and rigour. This paper is a discussion of some complexities encountered while exploring the literature on the Delphi technique, a research method we had believed to be straightforward. The Delphi method had been used extensively since its development in the 1950s, and its use in nursing research appears to be increasing. Our explorations revealed that, rather than a simple means of obtaining the judgments of experts, modifications and adaptations over the years have dramatically changed 'the' Delphi. Anyone wishing to use the method needs a sound knowledge of complex theoretical issues associated with its implementation.

Consultants↗

PubMedDate not supplied

The determination of relevant goals and criteria used to select an automated patient care information system: a Delphi approach.

OBJECTIVES: To determine the relevant weighted goals and criteria for use in the selection of an automated patient care information system (PCIS) using a modified Delphi technique to achieve consensus. DESIGN: A three-phase, six-round modified Delphi process was implemented by a ten-member PCIS selection task force. The first phase consisted of an exploratory round. It was followed by the second phase, of two rounds, to determine the selection goals and finally the third phase, of three rounds, to finalize the selection criteria. RESULTS: Consensus on the goals and criteria for selecting a PCIS was measured during the Delphi process by reviewing the mean and standard deviation of the previous round's responses. After the study was completed, the results were analyzed using a limits-of-agreement indicator that showed strong agreement of each individual's responses between each of the goal determination rounds. Further analysis for variability in the group's response showed a significant movement to consensus after the first goal-determination iteration, with consensus reached on all goals by the end of the second iteration. CONCLUSION: The results indicated that the relevant weighted goals and criteria used to make the final decision for an automated PCIS were developed as a result of strong agreement among members of the PCIS selection task force. It is therefore recognized that the use of the Delphi process was beneficial in achieving consensus among clinical and nonclinical members in a relatively short time while avoiding a decision based on political biases and the "groupthink" of traditional committee meetings. The results suggest that improvements could be made in lessening the number of rounds by having information available through side conversations, by having other statistical indicators besides the mean and standard deviation available between rounds, and by having a content expert address questions between rounds.

British Columbia↗

PubMed1999

Outcomes for community health nursing practice.

OBJECTIVE: The purpose of this study was to develop an easy, practical list of outcomes amenable to community health nursing interventions. This study sought to answer the following question: What outcomes are sensitive to nursing interventions in the community health setting? SUMMARY BACKGROUND DATA: Nursing literature discusses many client outcomes. However, available outcome lists are not always sensitive to nursing interventions by community health nurses. Nurses need a precise list to measure client outcomes resulting from contact between nurses and clients in a variety of community health settings. METHODS AND SUBJECTS: The study used a modified Delphi technique to ensure adequate response from the subjects. Initially, focus groups generated items for the Delphi questionnaires. Using items from the focus groups, the researchers developed three rounds of questionnaires. In each round, nurses stated a level of agreement with each item as an outcome for community health nurses. Twenty-two community health nurses in one Southeastern state participated in four focus groups. One hundred fifty-two community health nurses returned round 1 questionnaires, 68 nurses returned round 2 questionnaires, and 48 nurses returned round 3 questionnaires. RESULTS: The researchers grouped the outcomes into four domains: client's psychosocial components of care, client's physiologic components of care, nursing intervention/implementation components of care, and environmental/community safety components of care. CONCLUSIONS: The findings produced an easy, practical list of 48 nursing outcomes for use in decision making and research by community health nurses in all settings.

Community Health Nursing↗

PubMed1993

Characteristics of strong departments of family medicine: results of a Delphi survey.

BACKGROUND: The establishment and support of strong university-based departments of family medicine is central to the success of family practice. The purpose of this study was to provide existing and developing departments of family medicine with information on the characteristics of strong established departments. METHODS: Chairs of existing departments were asked to identify the five strongest university-based departments in the country. Based on an 80% response rate, a select group of 24 chairs representing the strongest departments was surveyed using a Delphi technique. RESULTS: A systems and contingency model was used as the basis for organizing the Delphi responses. Seven core factors were identified and ranked by the chairs for each of the six systems and subsystems of the model describing university-based departments. CONCLUSIONS: Key ingredients that are common to most strong departments are the ability of the department to respond to the external environment, the presence of state and federal financial support, leadership and vision by the chair, strong clinically oriented faculty, management practices that keep everyone informed, and mutual support and respect within the department.

Delphi Technique↗