McDonnell J, Meijler A, Kahan J P, Bernstein S J, Rigter H
Institute for Medical Technology Assessment, Erasmus University, Rotterdam, Netherlands.
Health Policy. 1996 Sep;37(3):139-52. doi: 10.1016/s0168-8510(96)90021-4.
Where information about the appropriateness of a surgical procedure is lacking, expert panels have been used to establish guidelines for medical practitioners. Such a panel was convened to assess the appropriateness of percutaneous transluminal coronary angioplasty and coronary artery bypass graft surgery in the Netherlands. The panel, consisting of interventional cardiologists and cardiothoracic surgeons, used a modified Delphi process to rate 1126 clinical indications over two rounds. This article describes the degree of change in both agreement amongst members and in the appropriateness ratings over the two rounds, and examines the internal consistency of the ratings of individual panellists. Over the two rounds, agreement increased. Although most appropriateness ratings remained unchanged, there was significant movement from equivocal ratings to determinate ratings. While individual members showed some degree of inconsistency in their scoring, the panel as a whole scored very consistently. The observed changes in appropriateness were consistent with expectations, showing that the appropriateness method is used logically and consistently by panellists.
在缺乏有关外科手术适当性信息的情况下，专家小组已被用于为执业医师制定指导方针。为此召集了一个小组来评估荷兰经皮腔内冠状动脉成形术和冠状动脉搭桥手术的适当性。该小组由介入心脏病学家和心胸外科医生组成，采用改良的德尔菲法对1126种临床适应症进行两轮评分。本文描述了两轮中成员间的一致性以及适当性评分的变化程度，并检验了各小组成员评分的内部一致性。在两轮中，一致性有所提高。虽然大多数适当性评分保持不变，但从模棱两可的评分到明确的评分有显著变化。虽然个别成员在评分上表现出一定程度的不一致，但整个小组的评分非常一致。观察到的适当性变化与预期一致，表明小组成员在逻辑上和一致地使用了适当性方法。
