Development of a Chinese medicine assessment measure: an interdisciplinary approach using the delphi method.
BACKGROUND
The diagnostic framework and clinical reasoning process in Chinese medicine emphasizes the contextual and qualitative nature of a patient's illness. Chinese medicine assessment data may help interpret clinical outcomes.


OBJECTIVE
As part of a study aimed at assessing the validity and improving the inter-rater reliability of the Chinese diagnostic process, a structured assessment instrument was developed for use in clinical trials of acupuncture and other Chinese medical therapies.


METHODS
To foster collaboration and maximize resources and information, an interdisciplinary advisory team was assembled. Under the guidance of two group process facilitators, and in order to establish whether the assessment instrument was consistent with accepted Chinese medicine diagnostic categories (face validity) and included the full range of each concept's meaning (content validity), a panel of Traditional Chinese Medicine (TCM) expert clinicians was convened and their responses were organized using the Delphi process, an iterative, anonymous, idea-generating and consensus-building process. An aggregate rating measure was obtained by taking the mean of mean ratings for each question across all 10 experts.


RESULTS
Over three rounds, the overall rating increased from 7.4 (SD = 1.3) in Round 1 to 9.1 (SD = 0.5) in Round 3. The level of agreement among clinicians was measured by a decrease in SD.


CONCLUSIONS
The final instrument TEAMSI-TCM (Traditional East Asian Medicine Structured Interview, TCM version) uses the pattern differentiation model characteristic of TCM. This modular, dynamic version was specifically designed to assess women, with a focus on gynecologic conditions; with modifications it can be adapted for use with other populations and conditions. TEAMSI-TCM is a prescriptive instrument that guides clinicians to use the proper indicators, combine them in a systematic manner, and generate conclusions. In conjunction with treatment manualization and training it may serve to increase inter-rater reliability and inter-trial reproducibility in Chinese medicine clinical trials. Testing of the validity and reliability of this instrument currently is underway.
Schnyer
Rosa N
RN
New England School of Acupuncture, Watertown, MA 02215, USA. Rosa_Schnyer@hms.harvard.edu
Conboy
Lisa A
LA
Jacobson
Eric
E
McKnight
Patrick
P
Goddard
Thomas
T
Moscatelli
Francesca
F
Legedza
Anna T R
AT
Kerr
Catherine
C
Kaptchuk
Ted J
TJ
Wayne
Peter M
PM
D003627:Data Interpretation, Statistical; D003697:Delphi Technique; D006801:Humans; D033183:Interdisciplinary Communication; D008516:Medicine, Chinese Traditional / Q000295:instrumentation* / Q000379:methods; D010348:Patient Care Team / Q000458:organization & administration; D010818:Practice Patterns, Physicians'; D016730:Program Development / Q000379:methods; D011594:Psychometrics / Q000295:instrumentation*; D015203:Reproducibility of Results