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Assessment of Competence in EVAR Procedures : A Novel Rating Scale Developed by the Delphi Technique

Strøm, M; Lönn, L; Bech, B; Schroeder, T V; Konge, L; , and Holst, Jan LU (2017) In European journal of vascular and endovascular surgery 54(1). p.34-41
Abstract

OBJECTIVE/BACKGROUND: To develop a procedure specific global rating scale for assessment of operator competence in endovascular aortic repair (EVAR).

METHODS: A Delphi approach was used to achieve expert consensus. A panel of 32 international experts (median 300 EVAR procedures, range 200-3000) from vascular surgery (n = 21) and radiology (n = 11) was established. The first Delphi round was based on a review of endovascular skills assessment papers, stent graft instructions for use, and structured interviews. It led to a primary pool of 83 items that were formulated as global rating scale items with tentative anchors. Iterative Delphi rounds were executed. The panellists rated the importance of each item on a 5 point Likert scale.... (More)

OBJECTIVE/BACKGROUND: To develop a procedure specific global rating scale for assessment of operator competence in endovascular aortic repair (EVAR).

METHODS: A Delphi approach was used to achieve expert consensus. A panel of 32 international experts (median 300 EVAR procedures, range 200-3000) from vascular surgery (n = 21) and radiology (n = 11) was established. The first Delphi round was based on a review of endovascular skills assessment papers, stent graft instructions for use, and structured interviews. It led to a primary pool of 83 items that were formulated as global rating scale items with tentative anchors. Iterative Delphi rounds were executed. The panellists rated the importance of each item on a 5 point Likert scale. Consensus was defined as 80% of the panel rating an item 4 or 5 in the primary round and 90% in subsequent rounds. Consensus on the final assessment tool was defined as Cronbach's alpha > .8 after a minimum of three rounds.

RESULTS: Thirty-two of 35 invited experts participated. Three rounds of surveys were completed with a completion rate of 100% in the first two rounds and 91% in round three. The 83 primary assessment items were supplemented with five items suggested by the panel and reduced to seven pivotal assessment items that reached consensus, Cronbach's alpha = 0.82. The seven item rating scale covers key elements of competence in EVAR stent placement and deployment. Each item has well defined grades with explicit anchors at unacceptable, acceptable, and superior performance on a 5 point Likert scale.

CONCLUSION: The Delphi methodology allowed for international consensus on a new procedure specific global rating scale for assessment of competence in EVAR. The resulting scale, EndoVascular Aortic Repair Assessment of Technical Expertise (EVARATE), represents key elements in the procedure. EVARATE constitutes an assessment tool for providing structured feedback to endovascular operators in training.

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author
publishing date
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Contribution to journal
publication status
published
subject
keywords
Adult, Aged, Aortic Aneurysm, Abdominal, Blood Vessel Prosthesis, Blood Vessel Prosthesis Implantation, Clinical Competence, Consensus, Delphi Technique, Endovascular Procedures, Female, Humans, Male, Middle Aged, Process Assessment (Health Care), Quality Indicators, Health Care, Stents, Task Performance and Analysis, Treatment Outcome, Journal Article
in
European journal of vascular and endovascular surgery
volume
54
issue
1
pages
8 pages
publisher
Elsevier
external identifiers
  • scopus:85019578820
ISSN
1532-2165
DOI
10.1016/j.ejvs.2017.04.001
language
English
LU publication?
no
id
1d2d165c-e4be-4340-b1af-afc32bf235fe
date added to LUP
2018-03-22 15:27:19
date last changed
2018-09-16 04:54:11
@article{1d2d165c-e4be-4340-b1af-afc32bf235fe,
  abstract     = {<p>OBJECTIVE/BACKGROUND: To develop a procedure specific global rating scale for assessment of operator competence in endovascular aortic repair (EVAR).</p><p>METHODS: A Delphi approach was used to achieve expert consensus. A panel of 32 international experts (median 300 EVAR procedures, range 200-3000) from vascular surgery (n = 21) and radiology (n = 11) was established. The first Delphi round was based on a review of endovascular skills assessment papers, stent graft instructions for use, and structured interviews. It led to a primary pool of 83 items that were formulated as global rating scale items with tentative anchors. Iterative Delphi rounds were executed. The panellists rated the importance of each item on a 5 point Likert scale. Consensus was defined as 80% of the panel rating an item 4 or 5 in the primary round and 90% in subsequent rounds. Consensus on the final assessment tool was defined as Cronbach's alpha &gt; .8 after a minimum of three rounds.</p><p>RESULTS: Thirty-two of 35 invited experts participated. Three rounds of surveys were completed with a completion rate of 100% in the first two rounds and 91% in round three. The 83 primary assessment items were supplemented with five items suggested by the panel and reduced to seven pivotal assessment items that reached consensus, Cronbach's alpha = 0.82. The seven item rating scale covers key elements of competence in EVAR stent placement and deployment. Each item has well defined grades with explicit anchors at unacceptable, acceptable, and superior performance on a 5 point Likert scale.</p><p>CONCLUSION: The Delphi methodology allowed for international consensus on a new procedure specific global rating scale for assessment of competence in EVAR. The resulting scale, EndoVascular Aortic Repair Assessment of Technical Expertise (EVARATE), represents key elements in the procedure. EVARATE constitutes an assessment tool for providing structured feedback to endovascular operators in training.</p>},
  author       = {Strøm, M and Lönn, L and Bech, B and Schroeder, T V and Konge, L and ,  and Holst, Jan},
  issn         = {1532-2165},
  keyword      = {Adult,Aged,Aortic Aneurysm, Abdominal,Blood Vessel Prosthesis,Blood Vessel Prosthesis Implantation,Clinical Competence,Consensus,Delphi Technique,Endovascular Procedures,Female,Humans,Male,Middle Aged,Process Assessment (Health Care),Quality Indicators, Health Care,Stents,Task Performance and Analysis,Treatment Outcome,Journal Article},
  language     = {eng},
  number       = {1},
  pages        = {34--41},
  publisher    = {Elsevier},
  series       = {European journal of vascular and endovascular surgery },
  title        = {Assessment of Competence in EVAR Procedures : A Novel Rating Scale Developed by the Delphi Technique},
  url          = {http://dx.doi.org/10.1016/j.ejvs.2017.04.001},
  volume       = {54},
  year         = {2017},
}