Publications by authors named "Douglas J Murphy"

12 Publications

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Medical appraisal: an amber zone of opportunity?

Med Educ 2017 10;51(10):986-988

Dundee, UK.

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http://dx.doi.org/10.1111/medu.13388DOI Listing
October 2017

Development and preliminary psychometric properties of the Care Experience Feedback Improvement Tool (CEFIT).

BMJ Open 2016 06 14;6(6):e010101. Epub 2016 Jun 14.

Quality, Safety and Informatics Research Group, University of Dundee, Dundee, UK.

Objective: To develop a structurally valid and reliable, yet brief measure of patient experience of hospital quality of care, the Care Experience Feedback Improvement Tool (CEFIT). Also, to examine aspects of utility of CEFIT.

Background: Measuring quality improvement at the clinical interface has become a necessary component of healthcare measurement and improvement plans, but the effectiveness of measuring such complexity is dependent on the purpose and utility of the instrument used.

Methods: CEFIT was designed from a theoretical model, derived from the literature and a content validity index (CVI) procedure. A telephone population surveyed 802 eligible participants (healthcare experience within the previous 12 months) to complete CEFIT. Internal consistency reliability was tested using Cronbach's α. Principal component analysis was conducted to examine the factor structure and determine structural validity. Quality criteria were applied to judge aspects of utility.

Results: CVI found a statistically significant proportion of agreement between patient and practitioner experts for CEFIT construction. 802 eligible participants answered the CEFIT questions. Cronbach's α coefficient for internal consistency indicated high reliability (0.78). Interitem (question) total correlations (0.28-0.73) were used to establish the final instrument. Principal component analysis identified one factor accounting for 57.3% variance. Quality critique rated CEFIT as fair for content validity, excellent for structural validity, good for cost, poor for acceptability and good for educational impact.

Conclusions: CEFIT offers a brief yet structurally sound measure of patient experience of quality of care. The briefness of the 5-item instrument arguably offers high utility in practice. Further studies are needed to explore the utility of CEFIT to provide a robust basis for feedback to local clinical teams and drive quality improvement in the provision of care experience for patients. Further development of aspects of utility is also required.
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http://dx.doi.org/10.1136/bmjopen-2015-010101DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4916633PMC
June 2016

Bad apples or spoiled barrels? Multilevel modelling analysis of variation in high-risk prescribing in Scotland between general practitioners and between the practices they work in.

BMJ Open 2015 Nov 6;5(11):e008270. Epub 2015 Nov 6.

NHS Tayside Medicines Governance Unit, Mackenzie Building, Kirsty Semple Way, Dundee, UK.

Objectives: Primary care high-risk prescribing causes significant harm, but it is unclear if it is largely driven by individuals (a 'bad apple' problem) or by practices having higher or lower risk prescribing cultures (a 'spoiled barrel' problem). The study aimed to examine the extent of variation in high-risk prescribing between individual prescribers and between the practices they work in.

Design, Setting And Participants: Multilevel logistic regression modelling of routine cross-sectional data from 38 Scottish general practices for 181,010 encounters between 398 general practitioners (GPs) and 26,539 patients particularly vulnerable to adverse drug events (ADEs) of non-steroidal anti-inflammatory drugs (NSAIDs) due to age, comorbidity or co-prescribing.

Outcome Measure: Initiation of a new NSAID prescription in an encounter between GPs and eligible patients.

Results: A new high-risk NSAID was initiated in 1953 encounters (1.1% of encounters, 7.4% of patients). Older patients, those with more vulnerabilities to NSAID ADEs and those with polypharmacy were less likely to have a high-risk NSAID initiated, consistent with GPs generally recognising the risk of NSAIDs in eligible patients. Male GPs were more likely to initiate a high-risk NSAID than female GPs (OR 1.73, 95% CI 1.39 to 2.16). After accounting for patient characteristics, 4.2% (95% CI 2.1 to 8.3) of the variation in high-risk NSAID prescribing was attributable to variation between practices, and 14.2% (95% CI 11.4 to 17.3) to variation between GPs. Three practices had statistically higher than average high-risk prescribing, but only 15.7% of GPs with higher than average high-risk prescribing and 18.5% of patients receiving such a prescription were in these practices.

Conclusions: There was much more variation in high-risk prescribing between GPs than between practices, and only targeting practices with higher than average rates will miss most high-risk NSAID prescribing. Primary care prescribing safety improvement should ideally target all practices, but encourage practices to consider and act on variation between prescribers in the practice.
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http://dx.doi.org/10.1136/bmjopen-2015-008270DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4636636PMC
November 2015

Instruments to measure patient experience of healthcare quality in hospitals: a systematic review.

Syst Rev 2015 Jul 23;4:97. Epub 2015 Jul 23.

School of Health Sciences, University of Stirling, Stirling, UK.

Background: Improving and sustaining the quality of hospital care is an international challenge. Patient experience data can be used to target improvement and research. However, the use of patient experience data has been hindered by confusion over multiple instruments (questionnaires) with unknown psychometric testing and utility.

Methods: We conducted a systematic review and utility critique of questionnaires to measure patient experience of healthcare quality in hospitals. Databases (Medical Literature Analysis and Retrieval System (MEDLINE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Psychological Information (PsychINFO) and Web of Knowledge until end of November 2013) and grey literature were scrutinised. Inclusion criteria were applied to all records with a 10 % sample independently checked. Critique included (1) application of COSMIN checklists to assess the quality of each psychometric study, (2) critique of psychometric results of each study using Terwee et al. criteria and (3) development and critique of additional aspects of utility for each instrument. Two independent reviewers completed each critique. Synthesis included combining findings in a utility matrix.

Results: We obtained 1157 records. Of these, 26 papers measuring patient experience of hospital quality of care were identified examining 11 international instruments. We found evidence of extensive theoretical/development work. The quality of methods and results was variable but mostly of a high standard. Additional aspects of utility found that (1) cost efficiency was mostly poor, due to the resource necessary to obtain reliable samples; (2) acceptability of most instruments was good and (3) educational impact was variable, with evidence on the ease of use, for approximately half of the questionnaires.

Conclusions: Selecting the right patient experience instrument depends on a balanced consideration of aspects of utility, aided by the matrix. Data required for high stakes purposes requires a high degree of reliability and validity, while those used for quality improvement may tolerate lower levels of reliability in favour of other aspects of utility (educational impact, cost and acceptability).

Systematic Review Registration: PROSPERO CRD42013006754.
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http://dx.doi.org/10.1186/s13643-015-0089-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4511995PMC
July 2015

Instruments to measure patient experience of health care quality in hospitals: a systematic review protocol.

Syst Rev 2014 Jan 4;3. Epub 2014 Jan 4.

School of Nursing, Midwifery and Health, University of Stirling, Highland Campus, Centre for Health Science, Old Perth Rd, Inverness IV2 3JH, UK.

Background: Improving and sustaining the quality of care in hospitals is an intractable and persistent challenge. The patients' experience of the quality of hospital care can provide insightful feedback to enable clinical teams to direct quality improvement efforts in areas where they are most needed. Yet, patient experience is often marginalised in favour of aspects of care that are easier to quantify (for example, waiting time). Attempts to measure patient experience have been hindered by a proliferation of instruments using various outcome measures with varying degrees of psychometric development and testing.

Methods/design: We will conduct a systematic review and utility critique of instruments used to measure patient experience of health care quality in hospitals. The databases Medical Literature Analysis and Retrieval System Online (MEDLINE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Psychological Information (Psych Info) and Web of Knowledge will be searched from inception until end November 2013. Search strategies will include the key words; patient, adult, hospital, secondary care, questionnaires, instruments, health care surveys, experience, satisfaction and patient opinion in various combinations. We will contact experts in the field of measuring patient experience and scrutinise all secondary references. A reviewer will apply an inclusion criteria scale to all titles and abstracts. A second reviewer will apply the inclusion criteria scale to a random 10% selection. Two reviewers will independently evaluate the methodological rigour of the testing of the instruments using the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist. Disagreements will be resolved through consensus. Instruments will be critiqued and grouped using van der Vleuten's utility index. We will present a narrative synthesis on the utility of all instruments and make recommendations for instrument selection in practice.

Discussion: This systematic review of the utility of instruments to measure patient experience of hospital quality care will aid clinicians, managers and policy makers to select an instrument fit for purpose. Importantly, appropriate instrument selection will provide a mechanism for patients' voices to be heard on the quality of care they receive in hospitals. PROSPERO registration CRD42013006754.
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http://dx.doi.org/10.1186/2046-4053-3-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3892022PMC
January 2014

Insightful practice: a reliable measure for medical revalidation.

BMJ Qual Saf 2012 Aug 31;21(8):649-56. Epub 2012 May 31.

Quality, Safety and Informatics Research Group, University of Dundee, Dundee, UK.

Background: Medical revalidation decisions need to be reliable if they are to reassure on the quality and safety of professional practice. This study tested an innovative method in which general practitioners (GPs) were assessed on their reflection and response to a set of externally specified feedback.

Setting And Participants: 60 GPs and 12 GP appraisers in the Tayside region of Scotland, UK.

Methods: A feedback dataset was specified as (1) GP-specific data collected by GPs themselves (patient and colleague opinion; open book self-evaluated knowledge test; complaints) and (2) Externally collected practice-level data provided to GPs (clinical quality and prescribing safety). GPs' perceptions of whether the feedback covered UK General Medical Council specified attributes of a 'good doctor' were examined using a mapping exercise. GPs' professionalism was examined in terms of appraiser assessment of GPs' level of insightful practice, defined as: engagement with, insight into and appropriate action on feedback data. The reliability of assessment of insightful practice and subsequent recommendations on GPs' revalidation by face-to-face and anonymous assessors were investigated using Generalisability G-theory.

Main Outcome Measures: Coverage of General Medical Council attributes by specified feedback and reliability of assessor recommendations on doctors' suitability for revalidation.

Results: Face-to-face assessment proved unreliable. Anonymous global assessment by three appraisers of insightful practice was highly reliable (G=0.85), as were revalidation decisions using four anonymous assessors (G=0.83).

Conclusions: Unlike face-to-face appraisal, anonymous assessment of insightful practice offers a valid and reliable method to decide GP revalidation. Further validity studies are needed.
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http://dx.doi.org/10.1136/bmjqs-2011-000429DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3404544PMC
August 2012

Microsatellite loci for dreissenid mussels (Mollusca: Bivalvia: Dreissenidae) and relatives: markers for assessing exotic and native populations.

Mol Ecol Resour 2011 Jul 1;11(4):725-32. Epub 2011 Apr 1.

Field Museum, 1400 S Lake Shore Dr, Chicago, IL 60605, USA.

We developed and tested 14 new polymorphic microsatellite loci for dreissenid mussels, including the two species that have invaded many freshwater habitats in Eurasia and North America, where they cause serious industrial fouling damage and ecological alterations. These new loci will aid our understanding of their genetic patterns in invasive populations as well as throughout their native Ponto-Caspian distributions. Eight new loci for the zebra mussel Dreissena polymorpha polymorpha and six for the quagga mussel D. rostriformis bugensis were compared with new results from six previously published loci to generate a robust molecular toolkit for dreissenid mussels and their relatives. Taxa tested include D. p. polymorpha, D. r. bugensis, D. r. grimmi, D. presbensis, the 'living fossil'Congeria kusceri, and the dark false mussel Mytilopsis leucophaeata (the latter also is invasive). Overall, most of the 24 zebra mussel (N = 583) and 13 quagga mussel (N = 269) population samples conformed to Hardy-Weinberg equilibrium expectations for the new loci following sequential Bonferroni correction. The 11 loci (eight new, three previously published) evaluated for D. p. polymorpha averaged 35.1 alleles and 0.72 mean observed heterozygosity per locus, and 25.3 and 0.75 for the nine loci (six new, three previously published) developed for D. r. bugensis. All but three of these loci successfully amplified the other species of Dreissena, and all but one also amplified Congeria and Mytilopsis. All species and populations tested were significantly divergent using the microsatellite data, with neighbour-joining trees reflecting their evolutionary relationships; our results reveal broad utility for resolving their biogeographic, evolutionary, population and ecological patterns.
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http://dx.doi.org/10.1111/j.1755-0998.2011.03012.xDOI Listing
July 2011

Microsatellite loci for Ponto-Caspian gobies: markers for assessing exotic invasions.

Mol Ecol Resour 2009 Mar 31;9(2):639-44. Epub 2009 Jan 31.

Field Museum of Natural History, 1400 South Lake Shore Drive, Chicago, IL 60605, USA Lake Erie Center and the Department of Environmental Sciences, The University of Toledo, 6200 Bayshore Road, Toledo, OH 43618, USA.

We developed and tested eight polymorphic microsatellite loci for Ponto-Caspian 'neogobiin' gobies, many of which are invasive in Eurasia and North America, whose study will aid understanding of the population genetics underlying their success. We tested samples from one to two locations from 12 taxa in the recently revised genera Babka, Benthophilus, Mesogobius, Neogobius = Apollonia, Ponticola and Proterorhinus; including the bighead, Caspian, knout, monkey, racer, round, tadpole and tubenose gobies; and taxa from introduced vs. native populations, those diverging between fresh and marine waters, and those differentiated between the Black and Caspian Seas. Populations conformed to Hardy-Weinberg equilibrium expectations, averaging five to 15 alleles per locus and 0.11 to 0.67 mean heterozygosity. Allelic variation significantly differentiated among all taxa and populations.
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http://dx.doi.org/10.1111/j.1755-0998.2008.02495.xDOI Listing
March 2009

The reliability of workplace-based assessment in postgraduate medical education and training: a national evaluation in general practice in the United Kingdom.

Adv Health Sci Educ Theory Pract 2009 May 28;14(2):219-32. Epub 2008 Feb 28.

Community Health Sciences Division, University of Dundee, Mackenzie Building, Kirsty Semple Way, Dundee DD24BF, UK.

To investigate the reliability and feasibility of six potential workplace-based assessment methods in general practice training: criterion audit, multi-source feedback from clinical and non-clinical colleagues, patient feedback (the CARE Measure), referral letters, significant event analysis, and video analysis of consultations. Performance of GP registrars (trainees) was evaluated with each tool to assess the reliabilities of the tools and feasibility, given raters and number of assessments needed. Participant experience of process determined by questionnaire. 171 GP registrars and their trainers, drawn from nine deaneries (representing all four countries in the UK), participated. The ability of each tool to differentiate between doctors (reliability) was assessed using generalisability theory. Decision studies were then conducted to determine the number of observations required to achieve an acceptably high reliability for "high-stakes assessment" using each instrument. Finally, descriptive statistics were used to summarise participants' ratings of their experience using these tools. Multi-source feedback from colleagues and patient feedback on consultations emerged as the two methods most likely to offer a reliable and feasible opinion of workplace performance. Reliability co-efficients of 0.8 were attainable with 41 CARE Measure patient questionnaires and six clinical and/or five non-clinical colleagues per doctor when assessed on two occasions. For the other four methods tested, 10 or more assessors were required per doctor in order to achieve a reliable assessment, making the feasibility of their use in high-stakes assessment extremely low. Participant feedback did not raise any major concerns regarding the acceptability, feasibility, or educational impact of the tools. The combination of patient and colleague views of doctors' performance, coupled with reliable competence measures, may offer a suitable evidence-base on which to monitor progress and completion of doctors' training in general practice.
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http://dx.doi.org/10.1007/s10459-008-9104-8DOI Listing
May 2009

Workplace-based assessment for general practitioners: using stakeholder perception to aid blueprinting of an assessment battery.

Med Educ 2008 Jan;42(1):96-103

National Health Service (NHS) Education for Scotland, West of Scotland Region, Glasgow, UK.

Context: The implementation of an assessment system may be facilitated by stakeholder agreement that appropriate qualities are being tested. This study investigated the extent to which stakeholders perceived 8 assessment formats (multiple-choice questions, objective structured clinical examination, video, significant event analysis, criterion audit, multi-source feedback, case analysis and patient satisfaction questionnaire) as able to assess varying qualities of doctors training in UK general practice.

Methods: Educationalists, general practice trainers and registrars completed a blueprinting style of exercise to rate the extent to which each evaluation format was perceived to assess each of 8 competencies derived primarily from the General Medical Council document 'Good Medical Practice'.

Results: There were high levels of agreement among stakeholders regarding the perceived qualities tested by the proposed formats (G = 0.82-0.93). Differences were found in participants' perceptions of how well qualities were able to be assessed and in the ability of the respective formats to test each quality. Multi-source feedback (MSF) was expected to assess a wide range of qualities, whereas Probity, Health and Ability to work with colleagues were limited in terms of how well they could be tested by the proposed formats.

Discussion: Awareness of the perceptions of stakeholders should facilitate the development and implementation of workplace-based assessment (WPBA) systems. These data shed light on the acceptability of various formats in a way that will inform further investigation of WPBA formats' validity and feasibility, while also providing evidence on which to base educational efforts regarding the value of each format.
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http://dx.doi.org/10.1111/j.1365-2923.2007.02952.xDOI Listing
January 2008

Broad- to fine-scale population genetic patterning in the smallmouth bass Micropterus dolomieu across the Laurentian Great Lakes and beyond: an interplay of behaviour and geography.

Mol Ecol 2007 Apr;16(8):1605-24

Great Lakes Genetics Laboratory, Lake Erie Center and Department of Environmental Sciences, The University of Toledo, 6200 Bayshore Road, Toledo, OH 43618, USA.

Analysis of population genetic relationships reveals the signatures of current processes such as spawning behaviour and migration, as well as those of historical events including vicariance and climate change. This study examines these signatures through testing broad- to fine-scale genetic patterns among smallmouth bass Micropterus dolomieu spawning populations across their native Great Lakes range and outgroup areas, with fine-scale concentration in Lake Erie. Our primary hypotheses include whether genetic patterns result from behavioural and/or geographical isolation, specifically: (i) Are spawning groups in interconnected waterways genetically separable? (ii) What is the degree of isolation across and among lakes, basins, and tributaries? (iii) Do genetic divergences correspond to geographical distances? and (iv) Are historical colonization patterns from glacial refugia retained? Variation at eight nuclear microsatellite DNA loci are analysed for 666 smallmouth bass from 28 locations, including 425 individuals in Lake Erie; as well as Lakes Superior, Huron, and Ontario, and outgroups from the Mississippi, Ohio, St. Lawrence, and Hudson River drainages. Results reveal marked genetic differences among lake and river populations, as well as surprisingly high divergences among closely spaced riverine sites. Results do not fit an isolation-by-geographical-distance prediction for fine-scale genetic patterns, but show weak correspondence across large geographical scales. Genetic relationships thus are consistent with hypotheses regarding divergent origins through vicariance in glacial refugia, followed by colonization pathways establishing modern-day Great Lakes populations, and maintenance through behavioural site fidelity. Conservation management practices thus should preserve genetic identity and unique characters among smallmouth bass populations.
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http://dx.doi.org/10.1111/j.1365-294X.2006.03168.xDOI Listing
April 2007
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