A mixed-method evaluation of the acceptability, appropriateness, and feasibility of using an actionable processes of care checklist for patients with persistent critical illness
Bibliographic record
Abstract
Abstract Background: Patients with persistent critical illness have care priorities distinct from those experiencing acute critical illness. We developed a checklist called ‘Action 11’ incorporating actionable priorities of care for these patients. Objective: Evaluate the acceptability, appropriateness, and feasibility of using the Action 11 checklist. Methods: Convergent mixed-method study in two units caring for patients with persistent critical illness (Unit 1 outside-; Unit 2 inside-critical care) of a community hospital in Canada. The checklist was used daily for four-weeks, then weekly for four-weeks. A sample of healthcare providers were recruited to evaluate checklist acceptability, appropriateness, and feasibility using a questionnaire and interviews. Results: We received 52 questionnaires and conducted 14 interviews (August – November 2022). Of the 52 completed questionnaires, 35 (67%), 42 (81%), and 41 (79%) had a score of ≥ 16 for acceptability, appropriateness, and feasibility. Of a maximum score of 20, the total mean (SD) scores for acceptability, appropriateness, and feasibility were 16.2 (2.9), 16.7 (2.4) and 17 (2.5), respectively. Participants from Unit 1 found the checklist more acceptable (mean difference 1.7 [0.2 – 3.29], 95% CI) and feasible (mean difference 1.46 [0.09 – 2.84], 95% CI) to use than those from Unit 2. Qualitative descriptions for acceptability (comprehensive, inclusive, straightforward, prevented omissions in care, and promoted professional accountability), appropriateness (suited patient needs and enabled a personalized, consistent and collaborative approach to care), and feasibility (embedding into existing rounding, tailored to unit processes, and through leadership support) were also positive, however, they did not explain differences in rated acceptability and feasibility between the two units. Conclusions: The Action 11 checklist was perceived as acceptable, appropriate, and feasible to use in units caring for patients with persistent critical illness. Larger-scale evaluation the of the Action11 checklist exploring its effect on care processes and patient outcomes is recommended.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.147 | 0.155 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.003 | 0.002 |
| Scholarly communication | 0.002 | 0.003 |
| Open science | 0.002 | 0.003 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".