JMIR Publications

ABSTRACT

Background:

The review of collateral information is an essential component of patient care. Though this is standard practice, minimal research has been devoted to quantifying collateral information collection and to understanding how collateral information translates to clinical decision-making. To address this, we developed and piloted a novel measure (the McLean collateral information and clinical actionability scale (M-CICAS)) to evaluate the types and number of collateral sources viewed and resulting actions made in a psychiatric setting.

Objective:

Study aims included: 1) feasibility testing of the M-CICAS measure, 2) validating this measure against clinician notes via medical records, and 3) evaluating whether reviewing a higher volume of collateral sources is associated with more clinical actions taken.

Methods:

For the M-CICAS measure, we developed a three-part instrument, focusing on measuring collateral sources reviewed, clinical actions taken, and shared decision-making between clinician and patient. We recruited clinicians providing psychotherapy services at McLean hospital (N = 7) to complete the M-CICAS measure after individual clinical sessions. We also independently completed the M-CICAS using only the clinician’s corresponding note from that session, in order to validate the reported measure against the electronic health record which served as the objective point of comparison. Based on this, we estimated inter-rater reliability, reporting validity and whether significant variance in clinical actions taken could be attributed to inter-clinician differences.

Results:

Study staff had high interrater reliability on the M-CICAS for the sources reviewed (r=0.98, P<.001) and actions taken (r=0.97, P <.001). Clinician and study staff ratings were moderately correlated and statistically significant on the M-CICAS summary scores for the sources viewed (r’s=0.24 and 0.25, P=.02202 and P=.0188, respectively). Univariate regression modelling demonstrated a significant association between collateral sources and clinical actions taken when clinicians completed the M-CICAS (B=.27, t=2.47, P =.015). Multilevel fixed slopes random intercepts model confirmed a significant association even when accounting for clinician differences (B=.23, t=2.13, P =.037).

Conclusions:

This pilot study establishes feasibility and preliminary validity for the M-CICAS measure in assessing collateral sources and clinical decision-making in psychiatry. This study also indicated that reviewing more collateral sources may lead to an increased number of clinical actions following a session.