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Two-step decision tree analysis helps inform updates of RT best practices, quality standards
Date:7/28/2014

In exercise one, the 454 standards were categorized using a two-step process. The first step was to categorize the standards according to the Donabedian model, which provides a framework for examining health services and evaluating quality of care using three categories: structure, process and outcome. This categorization resulted in groups of approximately 150 standards each, making an in-depth analysis difficult. To reduce the size of the groups, a second step was implemented to classify the 454 standards according to each standard's target group (patients, staff, equipment or clinical process, or organization). This two-step process resulted in 12 primary classifications with an average size of 40 standards. The resulting smaller group size helped in identifying duplicate standards and key quality measures. The evaluators' responses were examined for reliability using the Fleiss free marginal kappa. The agreement between the evaluators was fair (k from 0.21 to 0.40) or moderate (k from 0.41 to 0.60), meaning three or more reviewers assigned the same categories in both steps to 67 percent (304) of the 454 quality standards. In the Donabedian model step, three or more evaluators agreed on the classification for 93 percent (422) of the 454 standards.

A second exercise was conducted, to determine if greater consistency in categorizations could be achieved. The evaluators reassessed any standards that did not receive unanimous categorization (n=290) in the first exercise. The standards were again categorized using the Donabedian model. When the 290 reevaluations were combined with the 164 that received unanimous agreement in exercise one, the free marginal kappa improved to 0.71, which shows substantial agreement (k=0.61 to 0.80). In exercise two, 64 percent (290) were classified as structure, 26 percent (116) were classified for process, and 10 percent (45) were classified for outcome.

"This research provides a sound basis for refining the globa
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Contact: Michelle Kirkwood
press@astro.org
703-286-1600
American Society for Radiation Oncology
Source:Eurekalert

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