Measuring acceptability of clinical decision rules: validation of the Ottawa acceptability of decision rules instrument (OADRI) in four countries.
BACKGROUND
Clinical decision rules can benefit clinicians, patients, and health systems, but they involve considerable up-front development costs and must be acceptable to the target audience. No existing instrument measures the acceptability of a rule. The current study validated such an instrument.


METHODS
The authors administered the Ottawa Acceptability of Decision Rules Instrument (OADRI) via postal survey to emergency physicians from 4 regions (Australasia, Canada, United Kingdom, and United States), in the context of 2 recently developed rules, the Canadian C-Spine Rule (C-Spine) and the Canadian CT Head Rule (CT-Head). Construct validity of the 12-item instrument was evaluated by hypothesis testing.


RESULTS
As predicted by a priori hypotheses, OADRI scores were 1) higher among rule users than nonusers, 2) higher among those using the rule ''all of the time'' v. ''most of the time'' v. ''some of the time,'' and 3) higher among rule nonusers who would consider using a rule v. those who would not. We also examined explicit reasons given by respondents who said they would not use these rules. Items in the OADRI accounted for 85.5% (C- Spine) and 90.2% (CT-Head) of the reasons given for not considering a rule acceptable.


CONCLUSIONS
The OADRI is a simple, 12-item instrument that evaluates rule acceptability among clinicians. Potential uses include comparing multiple ''protorules'' during development, examining acceptability of a rule to a new audience prior to implementation, indicating barriers to rule use addressable by knowledge translation interventions, and potentially serving as a proxy measure for future rule use.
Brehaut
Jamie C
JC
Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, ON, Canada. jbrehaut@ohri.ca
Graham
Ian D
ID
Wood
Timothy J
TJ
Taljaard
Monica
M
Eagles
Debra
D
Lott
Alison
A
Clement
Catherine
C
Kelly
Anne-Maree
AM
Mason
Suzanne
S
Stiell
Ian G
IG
D044362:Australasia; D001930:Brain Injuries / Q000000981:diagnostic imaging; D002170:Canada; D002574:Cervical Vertebrae / Q000293:injuries*; D006259:Craniocerebral Trauma / Q000000981:diagnostic imaging*; D020000:Decision Support Systems, Clinical / Q000295:instrumentation / Q000592:standards*; D003661:Decision Support Techniques; D004059:Diffusion of Innovation; D004632:Emergency Medical Services; D004635:Emergency Medicine; D006801:Humans; D012680:Sensitivity and Specificity; D013124:Spinal Injuries / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed / Q000592:standards*; D006113:United Kingdom; D014481:United States