Clinician judgments of functional outcomes: how bias and perceived accuracy affect rating.
OBJECTIVE
To evaluate the accuracy of clinician judgments of patient function, the susceptibility of judges to bias, and the relation between a judge's degree of belief in his/her accuracy of classification to observed accuracy when using the FIM instrument.


METHODS
Fifty rehabilitation professionals.


METHODS
3 urban medical centers.


METHODS
Four randomized experiments among subjects to examine the effect of potentially biasing information on FIM ratings of patient vignettes. Participants answered 60 true/false questions regarding patient function and FIM score and indicated confidence in the accuracy of their answers.


METHODS
Manipulation of patient information.


METHODS
The standard FIM 7-point scale, observed proportion of correct responses to the 60 true/false questions, and a 6-category confidence scale for each of the 60 questions were used as dependent measures.


RESULTS
FIM ratings assigned to others biased participants' FIM ratings of patient vignettes. Functional ability was overestimated when ratings in other domains were high and underestimated when they were low. Participants were overconfident in their ability to answer FIM questions accurately across all professional disciplines.


CONCLUSIONS
Bias and poor judgment of level accuracy play a significant role in clinician ratings of patient functioning. Blind ratings and training in debiasing are potential solutions to the problem.
Wolfson
A M
AM
Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle 98195-6490, USA. aaron_wolfson@yahoo.com
Doctor
J N
JN
Burns
S P
SP
D000203:Activities of Daily Living; D000328:Adult; D015982:Bias; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D007600:Judgment; D008297:Male; D015588:Observer Variation; D012046:Rehabilitation; D018709:Statistics, Nonparametric; D014861:Washington