Measuring acceptability of clinical decision rules: validation of the Ottawa acceptability of decision rules instrument (OADRI) in four countries

Med Decis Making. 2010 May-Jun;30(3):398-408. doi: 10.1177/0272989X09344747. Epub 2009 Dec 30.


Background: Clinical decision rules can benefit clinicians, patients, and health systems, but they involve considerable up-front development costs and must be acceptable to the target audience. No existing instrument measures the acceptability of a rule. The current study validated such an instrument.

Methods: The authors administered the Ottawa Acceptability of Decision Rules Instrument (OADRI) via postal survey to emergency physicians from 4 regions (Australasia, Canada, United Kingdom, and United States), in the context of 2 recently developed rules, the Canadian C-Spine Rule (C-Spine) and the Canadian CT Head Rule (CT-Head). Construct validity of the 12-item instrument was evaluated by hypothesis testing.

Results: As predicted by a priori hypotheses, OADRI scores were 1) higher among rule users than nonusers, 2) higher among those using the rule ''all of the time'' v. ''most of the time'' v. ''some of the time,'' and 3) higher among rule nonusers who would consider using a rule v. those who would not. We also examined explicit reasons given by respondents who said they would not use these rules. Items in the OADRI accounted for 85.5% (C- Spine) and 90.2% (CT-Head) of the reasons given for not considering a rule acceptable.

Conclusions: The OADRI is a simple, 12-item instrument that evaluates rule acceptability among clinicians. Potential uses include comparing multiple ''protorules'' during development, examining acceptability of a rule to a new audience prior to implementation, indicating barriers to rule use addressable by knowledge translation interventions, and potentially serving as a proxy measure for future rule use.

Publication types

  • Validation Study

MeSH terms

  • Australasia
  • Brain Injuries / diagnostic imaging
  • Canada
  • Cervical Vertebrae / injuries*
  • Craniocerebral Trauma / diagnostic imaging*
  • Decision Support Systems, Clinical / instrumentation
  • Decision Support Systems, Clinical / standards*
  • Decision Support Techniques*
  • Diffusion of Innovation
  • Emergency Medical Services
  • Emergency Medicine*
  • Humans
  • Sensitivity and Specificity
  • Spinal Injuries / diagnostic imaging*
  • Tomography, X-Ray Computed / standards*
  • United Kingdom
  • United States