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122 Abtahi et al. | Journal of Clinical and Translational Research 2024; 10(2): 119-140
and interest in the study would be invited to participate in the (i.e., 0.62) were considered “essential,” implying an agreement
study as well. With reference to the Lawshe table [31], the number from more than half of the clinical experts on the particular item.
of participants was limited to 10 clinical experts for an optimal A sub-zero CVR would indicate that less than half of the clinical
content validity ratio (CVR) during expert agreement analysis. experts considered an item “essential,” and the item would
subsequently be rejected [33,34]. All of the results were analyzed
2.3.3. Conducting the questionnaire-based survey using IBM statistical package for the social sciences v20.
We conducted the questionnaire-based survey by initially 3. Results
sharing an online link to the questionnaire with the clinical experts
through email or social network. The objective of the survey This study was conducted in various steps, and the results
was explained to the clinical experts through the same email or of each step, with the identified factors and their frequency, are
content of the message (if the experts were contacted via social represented in Figure 2.
network). The clinical experts would confirm their participation The possible outcomes identified from the literature review in
with a declaration. CVR [31] was utilized to quantitatively the first step were divided into six possible categories (as follows):
evaluate content validity, and the content validity index (CVI) (i) Length of stay: The length of stay is a clinical metric that
was calculated for each data element. The CVR corresponded to measures the time elapsed between a patient’s hospital
the essentiality or effectiveness of each item in clinical decision- admittance and discharge [35].
making for COVID-19 patients. (ii) Ward referrals: Ward referrals involve directing a patient to a
The critical threshold of CVR refers to the minimum CVR different hospital ward based on their specific medical condition.
critical value for each item. Based on Lawshe’s table [32], the (iii) Home referrals: Home referrals involve recommending and
critical threshold of CVR was set at 0.62 per the number of clinical arranging for patients to receive care in the comfort of their
experts (i.e., 10 clinical experts in this case). own homes instead of being admitted to a medical facility.

2.3.4. Analysis of panel results (iv) Deterioration diagnosis: Deterioration diagnosis indicates the
worsening of a patient’s health condition which can happen at
The literature review generated a list of factors that could any point while they are hospitalized.
effectively decide a patient’s outcome. Herein, we added several (v) Discharge: Discharge is when a patient is permitted to leave
criteria when interpreting the results. If the CVR of an item was the hospital following the receipt of treatment and care.
greater or equal to the CVR threshold, the item was considered (vi) ICU referrals: ICU referrals entail recognizing patients in need
“critical.” Items with CVR between zero to the threshold value of specialized care and moving them to the ICU for treatment.

Figure 2. The study process included a systematic review and the validation analysis of factors affecting the physicians’ decision-making for
COVID-19 patients.
DOI: https://doi.org/10.36922/jctr.22.00226