MDM policy & practice最新文献

{"title":"Development, Validation, and Implementation of a Medical Judgment Metric.","authors":"Rami A Ahmed,&nbsp;Michele L McCarroll,&nbsp;Alan Schwartz,&nbsp;M David Gothard,&nbsp;S Scott Atkinson,&nbsp;Patrick G Hughes,&nbsp;Jose Ramon Cepeda Brito,&nbsp;Lori Assad,&nbsp;Jerry G Myers,&nbsp;Richard L George","doi":"10.1177/2381468317715262","DOIUrl":"https://doi.org/10.1177/2381468317715262","url":null,"abstract":"<p><p><b>Background:</b> Medical decision making is a critical, yet understudied, aspect of medical education. <b>Aims:</b> To develop the Medical Judgment Metric (MJM), a numerical rubric to quantify good decisions in practice in simulated environments; and to obtain initial preliminary evidence of reliability and validity of the tool. <b>Methods:</b> The individual MJM items, domains, and sections of the MJM were built based on existing standardized frameworks. Content validity was determined by a convenient sample of eight experts. The MJM instrument was pilot tested in four medical simulations with a team of three medical raters assessing 40 participants with four levels of medical experience and skill. <b>Results:</b> Raters were highly consistent in their MJM scores in each scenario (intraclass correlation coefficient 0.965 to 0.987) as well as their evaluation of the expected patient outcome (Fleiss's Kappa 0.791 to 0.906). For each simulation scenario, average rater cut-scores significantly predicted expected loss of life or stabilization (Cohen's Kappa 0.851 to 0.880). <b>Discussion</b>: The MJM demonstrated preliminary evidence of reliability and validity.</p>","PeriodicalId":520707,"journal":{"name":"MDM policy & practice","volume":" ","pages":"2381468317715262"},"PeriodicalIF":0.0,"publicationDate":"2017-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2381468317715262","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36559726","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Life Expectancy Predictions for Older Diabetic Patients as Estimated by Physicians and a Prognostic Model.","authors":"Claire E O'Hanlon,&nbsp;Jennifer M Cooper,&nbsp;Sang Mee Lee,&nbsp;Priya John,&nbsp;Matthew Churpek,&nbsp;Marshall H Chin,&nbsp;Elbert S Huang","doi":"10.1177/2381468317713718","DOIUrl":"https://doi.org/10.1177/2381468317713718","url":null,"abstract":"<p><p><b>Background:</b> Multiple medical organizations recommend using life expectancy (LE) to individualize diabetes care goals. We compare the performance of patient LE predictions made by physicians to LE predictions from a simulation model (the Chicago model) in a cohort of older diabetic patients.</p><p><strong>Design: </strong>Retrospective cohort study of a convenience sample (n = 447) of diabetes patients over 65 years and their physicians. <b>Measurements:</b> Physicians provided LE estimates for individual patients during a baseline survey (2000-2003). The prognostic model included a comprehensive geriatric type 2 diabetes simulation model (the Chicago model) and combinations of the physician estimate and the Chicago model (\"And,\" \"Or,\" and \"Average\" models). Observed survival was determined based on the National Death Index through 31 December 2010. The predictive accuracy of LE predictions was assessed using c-statistic for 5-year mortality; Harrell's c-statistic, and Integrated Brier score for overall survival. <b>Results:</b> The patient cohort had a mean (SD) age of 73.4 (5.9) years. The majority were female (62.6%) and black (79.4%). At 5 years, 108 (24.2%) patients had died. The c-statistic for 5-year mortality was similar for physicians (0.69) and the Chicago model (0.68), while the average of estimates by physicians and Chicago model yielded the highest c-statistic of any method tested (0.73). The estimates of overall survival yielded a similar pattern of results. <b>Limitations:</b> Generalizability of patient cohort and lack of updated model parameters. <b>Conclusions:</b> Compared with individual methods, the average of LE estimates by physicians and the Chicago model had the best predictive performance. Prognostic models, such as the Chicago model, may complement and support physicians' intuitions as they consider treatment decisions and goals for older patients with chronic conditions like diabetes.</p>","PeriodicalId":520707,"journal":{"name":"MDM policy & practice","volume":" ","pages":"2381468317713718"},"PeriodicalIF":0.0,"publicationDate":"2017-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2381468317713718","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36559724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficient and Fair Heart Allocation Policies for Transplantation.","authors":"Farhad Hasankhani,&nbsp;Amin Khademi","doi":"10.1177/2381468317709475","DOIUrl":"https://doi.org/10.1177/2381468317709475","url":null,"abstract":"<p><p><b>Background:</b> The optimal allocation of limited donated hearts to patients on the waiting list is one of the top priorities in heart transplantation management. We developed a simulation model of the US waiting list for heart transplantation to investigate the potential impacts of allocation policies on several outcomes such as pre- and posttransplant mortality. <b>Methods:</b> We used data from the United Network for Organ Sharing (UNOS) and the Scientific Registry of Transplant Recipient (SRTR) to simulate the heart allocation system. The model is validated by comparing the outcomes of the simulation with historical data. We also adapted fairness schemes studied in welfare economics to provide a framework to assess the fairness of allocation policies for transplantation. We considered three allocation policies, each a modification to the current UNOS allocation policy, and analyzed their performance via simulation. The first policy broadens the geographical allocation zones, the second modifies the health status order for receiving hearts, and the third prioritizes patients according to their waiting time. <b>Results:</b> Our results showed that the allocation policy similar to the current UNOS practice except that it aggregates the three immediate geographical allocation zones, improves the health outcomes, and is \"closer\" to an optimal fair policy compared to all other policies considered in this study. Specifically, this policy could have saved 319 total deaths (out of 3738 deaths) during the 2006 to 2014 time horizon, in average. This policy slightly differs from the current UNOS allocation policy and allows for easy implementation. <b>Conclusion:</b> We developed a model to compare the outcomes of heart allocation policies. Combining the three immediate geographical zones in the current allocation algorithm could potentially reduce mortality rate and is closer to an optimal fair policy.</p>","PeriodicalId":520707,"journal":{"name":"MDM policy & practice","volume":" ","pages":"2381468317709475"},"PeriodicalIF":0.0,"publicationDate":"2017-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2381468317709475","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36559721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Parental Preferences for the Organization of Preschool Vaccination Programs Including Financial Incentives: A Discrete Choice Experiment.","authors":"Darren Flynn, Laura Ternent, Frauke Becker, Yemi Oluboyede, Jean Adams","doi":"10.1177/2381468317708319","DOIUrl":"10.1177/2381468317708319","url":null,"abstract":"<p><p><b>Objective:</b> To establish preferences of parents and guardians of preschool children for the organization of preschool vaccination services, including financial incentives. <b>Design:</b> An online discrete choice experiment. <b>Participants:</b> Parents and guardians of preschool children (up to age 5 years) who were (n = 259) and were not (n = 262) classified as at high risk of incompletely vaccinating their children. High risk of incomplete vaccination was defined as any of the following: aged less than 20 years, single parents, living in one of the 20% most deprived areas in England, had a preschool child with a disability, or had more than three children. <b>Main Outcome Measures:</b> Participant preferences expressed as positive (utility) or negative (disutility) on eight attributes and levels describing the organization of preschool vaccination programs. <b>Results:</b> There was no difference in preference for parental financial incentives compared to no incentive in parents \"not at high risk\" of incomplete vaccination. Parents who were \"at high risk\" expressed utility for cash incentives. Parents \"at high risk\" of incomplete vaccination expressed utility for information on the risks and benefits of vaccinations to be provided as numbers rather than charts or pictures. Both groups preferred universally available, rather than targeted, incentives. Utility was identified for shorter waiting times, and there were variable preferences for who delivered vaccinations. <b>Conclusions:</b> Cash incentives for preschool vaccinations in England would be welcomed by parents who are \"at high risk\" of incompletely vaccinating their children. Further work is required on the optimal mode and form of presenting probabilistic information on vaccination to parents/guardians, including preferences on mandatory vaccination schemes.</p>","PeriodicalId":520707,"journal":{"name":"MDM policy & practice","volume":" ","pages":"2381468317708319"},"PeriodicalIF":0.0,"publicationDate":"2017-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/1a/97/10.1177_2381468317708319.PMC6124929.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36559722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adjuvant Versus Salvage Radiotherapy for Patients With Adverse Pathological Findings Following Radical Prostatectomy: A Decision Analysis.","authors":"Christopher J D Wallis,&nbsp;Gerard Morton,&nbsp;Angela Jerath,&nbsp;Raj Satkunasviam,&nbsp;Ewa Szumacher,&nbsp;Sender Herschorn,&nbsp;Ronald T Kodama,&nbsp;Girish S Kulkarni,&nbsp;David Naimark,&nbsp;Robert K Nam","doi":"10.1177/2381468317709476","DOIUrl":"https://doi.org/10.1177/2381468317709476","url":null,"abstract":"<p><p><b>Background:</b> Patients undergoing surgery for prostate cancer who have adverse pathological findings experience high rates of recurrence. While there are data supporting adjuvant radiotherapy compared to a wait-and-watch strategy to reduce recurrence rates, there are no randomized controlled trials comparing adjuvant radiotherapy with the other standard of care, salvage radiotherapy (radiotherapy administered at the time of recurrence). <b>Methods:</b> We constructed a health state transition (Markov) model employing two-dimensional Monte Carlo simulation using a lifetime horizon to compare the quality-adjusted survival associated with postoperative strategies using adjuvant or salvage radiotherapy. Prior to analysis, we calibrated and validated our model using the results of previous randomized controlled trials. We considered clinically important oncological health states from immediately postoperative to prostate cancer-specific death, commonly described complications from prostate cancer treatment, and other causes of mortality. Transition probabilities and utilities for disease states were derived from a literature search of MEDLINE and expert consensus. <b>Results:</b> Salvage radiotherapy was associated with an increased quality-adjusted life expectancy (QALE) (58.3 months) as compared with adjuvant radiotherapy (53.7 months), a difference of 4.6 months (standard deviation 8.8). Salvage radiotherapy had higher QALE in 53% of hypothetical cohorts. There was a minimal difference in overall life expectancy (-0.1 months). Examining recurrence rates, our model showed validity when compared with available randomized controlled data. <b>Conclusions:</b> A salvage radiotherapy strategy appears to provide improved QALE for patients with adverse pathological findings following radical prostatectomy, compared with adjuvant radiotherapy. As these findings reflect, population averages, specific patient and tumor factors, and patient preferences remain central for individualized management.</p>","PeriodicalId":520707,"journal":{"name":"MDM policy & practice","volume":" ","pages":"2381468317709476"},"PeriodicalIF":0.0,"publicationDate":"2017-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2381468317709476","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36559723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Encouraging Medicare Advantage Enrollees to Switch to Higher Quality Plans: Assessing the Effectiveness of a \"Nudge\" Letter.","authors":"Benjamin L Howell,&nbsp;Partha Deb,&nbsp;Sai Ma,&nbsp;Rachel O Reid,&nbsp;Jesse Levy,&nbsp;Gerald F Riley,&nbsp;Patrick H Conway,&nbsp;William H Shrank","doi":"10.1177/2381468317707206","DOIUrl":"https://doi.org/10.1177/2381468317707206","url":null,"abstract":"<p><p>There are considerable quality differences across private Medicare Advantage insurance plans, so it is important that beneficiaries make informed choices. During open enrollment for the 2013 coverage year, the Centers for Medicare & Medicaid Services sent letters to beneficiaries enrolled in low-quality Medicare Advantage plans (i.e., plans rated less than 3 stars for at least 3 consecutive years by Medicare) explaining the stars and encouraging them to reexamine their choices. To understand the effectiveness of these low-cost, behavioral \"nudge\" letters, we used a beneficiary-level national retrospective cohort and performed multivariate regression analysis of plan selection during the 2013 open enrollment period among those enrolled in plans rated less than 3 stars. Our analysis controls for beneficiary demographic characteristics, health and health care spending risks, the availability of alternative higher rated plan options in their local market, and historical disenrollment rates from the plans. We compared the behaviors of those beneficiaries who received the nudge letters with those who enrolled in similar poorly rated plans but did not receive such letters. We found that beneficiaries who received the nudge letter were almost twice as likely (28.0% [95% confidence interval = 27.7%, 28.2%] vs. 15.3% [95% confidence interval = 15.1%, 15.5%]) to switch to a higher rated plan compared with those who did not receive the letter. White beneficiaries, healthier beneficiaries, and those residing in areas with more high-performing plan choices were more likely to switch plans in response to the nudge. Our findings highlight both the importance and efficacy of providing timely and actionable information to beneficiaries about quality in the insurance marketplace to facilitate informed and value-based coverage decisions.</p>","PeriodicalId":520707,"journal":{"name":"MDM policy & practice","volume":" ","pages":"2381468317707206"},"PeriodicalIF":0.0,"publicationDate":"2017-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2381468317707206","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36559720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Illustration of the Impact of Unmeasured Confounding Within an Economic Evaluation Based on Nonrandomized Data.","authors":"Jason R Guertin,&nbsp;James M Bowen,&nbsp;Guy De Rose,&nbsp;Daria J O'Reilly,&nbsp;Jean-Eric Tarride","doi":"10.1177/2381468317697711","DOIUrl":"https://doi.org/10.1177/2381468317697711","url":null,"abstract":"<p><p><b>Background:</b> Propensity score (PS) methods are frequently used within economic evaluations based on nonrandomized data to adjust for measured confounders, but many researchers omit the fact that they cannot adjust for unmeasured confounders. <b>Objective:</b> To illustrate how confounding due to unmeasured confounders can bias an economic evaluation despite PS matching. <b>Methods:</b> We used data from a previously published nonrandomized study to select a prematched population consisting of 121 patients (46.5%) who received endovascular aneurysm repair (EVAR) and 139 patients (53.5%) who received open surgical repair (OSR), in which sufficient data regarding eight measured confounders were available. One-to-one PS matching was used within this population to select two PS-matched subpopulations. The Matched PS-Smoking Excluded Subpopulation was selected by matching patients using a PS model that omitted patients' smoking status (one of the measured confounders), whereas the Matched PS-Smoking Included Subpopulation was selected by matching patients using a PS model that included all eight measured confounders. Incremental cost-effectiveness ratios (ICERs) were assessed within both subpopulations. <b>Results:</b> Both subpopulations were composed of two different sets of 164 patients. Balance within the Matched PS-Smoking Excluded Subpopulation was achieved on all confounders except for patients' smoking status, whereas balance within the Matched PS-Smoking Included Subpopulation was achieved on all confounders. Results indicated that the ICER of EVAR over OSR differed between both subpopulations; the ICER was estimated at $157,909 per life-year gained (LYG) within the Matched PS-Smoking Excluded Subpopulation, while it was estimated at $235,074 per LYG within the Matched PS-Smoking Included Subpopulation. <b>Discussion:</b> Although effective in controlling for measured confounding, PS matching may not adjust for unmeasured confounders that may bias the results of an economic evaluation based on nonrandomized data.</p>","PeriodicalId":520707,"journal":{"name":"MDM policy & practice","volume":" ","pages":"2381468317697711"},"PeriodicalIF":0.0,"publicationDate":"2017-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2381468317697711","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36559719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The External Validity of Mapping MSIS-29 on EQ-5D Among Individuals With Multiple Sclerosis in Sweden.","authors":"Olivia Ernstsson,&nbsp;Petter Tinghög,&nbsp;Kristina Alexanderson,&nbsp;Jan Hillert,&nbsp;Kristina Burström","doi":"10.1177/2381468317692806","DOIUrl":"https://doi.org/10.1177/2381468317692806","url":null,"abstract":"<p><p><b>Background:</b> Mapping can be performed to predict utility values from condition-specific measures when preference-based measures are absent. A previously developed algorithm that predicts EQ-5D-3L index values from the Multiple Sclerosis Impact Scale (MSIS-29) has not yet been externally validated. <b>Aim:</b> To examine the external validity of a previously developed mapping algorithm by testing the accuracy of predicting EQ-5D-3L index values from MSIS-29 among multiple sclerosis (MS) patients in Sweden. <b>Methods:</b> Cross-sectional individual-level data were collected from population-based Swedish registers between 2011 and 2014. Health-related quality of life was assessed through MSIS-29 and EQ-5D-3L at one point in time among 767 individuals with known disability level of MS. A previously developed mapping algorithm was applied to predict EQ-5D index values from MSIS-29 items, and the predictive accuracy was assessed through mean absolute error and root mean square error. <b>Results:</b> When applying the algorithm, the predicted mean EQ-5D-3L index value was 0.77 compared to the observed mean index value of 0.75. Prediction error was higher for individuals reporting EQ-5D values <0.5 compared to individuals reporting EQ-5D values ≥0.5. Mean absolute error (0.12) and root mean square error (0.18) were smaller or equal to the prediction errors found in the original mapping study. <b>Conclusion:</b> The mapping algorithm had similar predictive accuracy in the two independent samples although results showed that the highest predictive performance was found in groups with better health. Varied predictive accuracy in subgroups is consistent with previous studies and strategies to deal with this are warranted.</p>","PeriodicalId":520707,"journal":{"name":"MDM policy & practice","volume":" ","pages":"2381468317692806"},"PeriodicalIF":0.0,"publicationDate":"2017-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2381468317692806","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36559782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Designing the Free Drugs List in Nepal: A Balancing Act Between Technical Strengths and Policy Processes.","authors":"Devika Singh,&nbsp;Alia Cynthia Gonzales Luz,&nbsp;Waranya Rattanavipapong,&nbsp;Yot Teerawattananon","doi":"10.1177/2381468317691766","DOIUrl":"https://doi.org/10.1177/2381468317691766","url":null,"abstract":"<p><p>As more countries provide free health care, pharmaceutical reimbursement lists are becoming a concern, especially in low- and middle-income countries. In 2007, Nepal decreed that health is a human right and began basic health coverage for a target group of the poor, destitute, elderly, and disabled. The Ministry of Health and Population (MoHP) also provided 40 drugs without cost to all citizens through the Free Drugs List (FDL) program. The FDL was later expanded from 40 to 70 drugs; however, the process of review and update remains unclear. To propose a mechanism for future development of the FDL, we conducted a document review and in-depth consultations with representatives from the MoHP and the World Health Organization Country Office during a workshop in Kathmandu. The FDL suffers from lack of an appropriate process, gaps between the listed drugs and Nepal's burden of disease, and no consideration of the unit costs or cost-effectiveness of drugs included in the list. We propose a new drug selection process that is a variant of the health technology assessment process. This process can be applied not only in Nepal but also in other resource-limited countries that wish to ensure their citizens' access to essential medicines through a pharmaceutical reimbursement list.</p>","PeriodicalId":520707,"journal":{"name":"MDM policy & practice","volume":" ","pages":"2381468317691766"},"PeriodicalIF":0.0,"publicationDate":"2017-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2381468317691766","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36559781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and Validation of a Genomic Knowledge Scale to Advance Informed Decision Making Research in Genomic Sequencing.","authors":"Michelle M Langer,&nbsp;Myra I Roche,&nbsp;Noel T Brewer,&nbsp;Jonathan S Berg,&nbsp;Cynthia M Khan,&nbsp;Cristina Leos,&nbsp;Elizabeth Moore,&nbsp;Michelle Brown,&nbsp;Christine Rini","doi":"10.1177/2381468317692582","DOIUrl":"https://doi.org/10.1177/2381468317692582","url":null,"abstract":"<p><strong>Background: </strong>This study evaluated the psychometric properties of a new, comprehensive measure of knowledge about genomic sequencing, the University of North Carolina Genomic Knowledge Scale (UNC-GKS).</p><p><strong>Methods: </strong>The UNC-GKS assesses knowledge in four domains thought to be critical for informed decision making about genomic sequencing. The scale was validated using classical test theory and item response theory in 286 adult patients and 132 parents of pediatric patients undergoing diagnostic whole exome sequencing (WES) in the NCGENES study.</p><p><strong>Results: </strong>The UNC-GKS assessed a single underlying construct (genomic knowledge) with good internal reliability (Cronbach's alpha = 0.90). Scores were most informative (able to discriminate between individuals with different levels of genomic knowledge) at one standard deviation above the scale mean or lower, a range that included most participants. Convergent validity was supported by associations with health literacy and numeracy (<i>r</i>s=0.41-0.46). The scale functioned well across subgroups differing in sex, race/ethnicity, education, and English proficiency.</p><p><strong>Discussion: </strong>Findings supported the promise of the UNC-GKS as a valid and reliable measure of genomic knowledge among people facing complex decisions about WES and comparable sequencing methods. It is neither disease- nor population-specific, and it functioned well across important subgroups, making it usable in diverse populations.</p>","PeriodicalId":520707,"journal":{"name":"MDM policy & practice","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2381468317692582","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36245694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}