title: The reliability of survey assessments of characteristics of medical clinics.
abstract: OBJECTIVE
  To assess the reliability of survey measures of organizational characteristics based on reports of single and multiple informants.
  
  
  METHODS
  Survey of 330 informants in 91 medical clinics providing care to HIV-infected persons under Title III of the Ryan White CARE Act.
  
  
  METHODS
  Cross-sectional survey.
  
  
  METHODS
  Surveys of clinicians and medical directors measured the implementation of quality improvement initiatives, priorities assigned to aspects of HIV care, barriers to providing high-quality HIV care, and quality improvement activities. Reliability of measures was assessed using generalizability coefficients. Components of variance and clinician-director differences were estimated using hierarchical regression models with survey items and informants nested within organizations.
  
  
  RESULTS
  There is substantial item- and informant-related variability in clinic assessments that results in modest or low clinic-level reliability for many measures. Directors occasionally gave more optimistic assessments of clinics than did clinicians.
  
  
  CONCLUSIONS
  For most measures studied, obtaining adequate reliability requires multiple informants. Using multiple-item scales or multiple informants can improve the psychometric performance of measures of organizational characteristics. Studies of such characteristics should report the organizational level reliability of the measures used.
authors.affiliation: Department of Sociology, Harvard University, Cambridge, MA 02138, USA.
authors.forename: Peter V
authors.initials: PV
authors.lastname: Marsden
authors.forename: Bruce E
authors.initials: BE
authors.lastname: Landon
authors.forename: Ira B
authors.initials: IB
authors.lastname: Wilson
authors.forename: Keith
authors.initials: K
authors.lastname: McInnes
authors.forename: Lisa R
authors.initials: LR
authors.lastname: Hirschhorn
authors.forename: Lin
authors.initials: L
authors.lastname: Ding
authors.forename: Paul D
authors.initials: PD
authors.lastname: Cleary
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities / Q000458:organization & administration / Q000592:standards*; D003430:Cross-Sectional Studies; D003627:Data Interpretation, Statistical; D005260:Female; D015658:HIV Infections; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires; D014481:United States