title: Reliability in patient-centered observations of family physicians.
abstract: OBJECTIVE
  Patient-centered communication is an important component of primary care and related to improved patient health outcomes and satisfaction. The Patient-Centered Observation Form (PCOF) was developed as an educational assessment tool to improve resident physician-patient communication. However, reliability of the tool has not been tested.
  
  
  METHODS
  Residents and patients were observed in routine medical encounters in a Midwestern family medicine residency center as part of a prospective, quasi-experimental study. Four independent observers (two faculty clinicians and two social scientists) used the PCOF to rate videorecorded patient encounters in the areas of establishing rapport, maintaining relationships, agenda setting, efficiency, information gathering, assessing patient perspectives, effective and open use of the electronic medical record (EMR), sharing information, discussion of behavior changes, co-creating a plan, and shared decision making.
  
  
  RESULTS
  A total of 13 physician-patient encounters were observed. Mean overall reliability for the PCOF was 0.67 using four raters, 0.45 for clinicians only, and 0.62 for social scientists. Adequate reliability (>0.7) was found for behavior change discussion (0.89) in clinician ratings but not with social scientists (0.62). Social scientists had adequate reliability in assessing patients' perspectives on health (0.86) and shared decision making (0.78), but these were not considered reliable among clinicians (0.46 and 0.00, respectively).
  
  
  CONCLUSIONS
  Reliability of the PCOF for assessing patient-centered competence is dependent on the content of communication being scored and the training history of the evaluator. These results challenge researchers and physicians to develop more reliable scoring instructions and tools for assessing patient-centered competence.
authors.affiliation: Department of Family and Community Medicine, University of Kansas School of Medicine-Wichita, Wichita, KS 67214-3199, USA. achesser@kumc.edu
authors.forename: Amy
authors.initials: A
authors.lastname: Chesser
authors.forename: Jared
authors.initials: J
authors.lastname: Reyes
authors.forename: Nikki Keene
authors.initials: NK
authors.lastname: Woods
authors.forename: Kim
authors.initials: K
authors.lastname: Williams
authors.forename: Robert
authors.initials: R
authors.lastname: Kraft
mesh_terms: D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003142:Communication; D005194:Family Practice / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D018802:Patient-Centered Care / Q000379:methods*; D010817:Physician-Patient Relations; D011446:Prospective Studies; D015203:Reproducibility of Results; D014481:United States