Fitch K, Lázaro P, Aguilar M D, Kahan J P, van het Loo M, Bernstein S J
Health Services Research Unit, Carlos III Health Institute, Madrid, Spain.
Eur J Cardiothorac Surg. 2000 Oct;18(4):380-7. doi: 10.1016/s1010-7940(00)00530-3.
Large variations in the use of coronary revascularization procedures have led many countries to apply the RAND appropriateness method to develop specific criteria describing patients who should be offered these procedures. The method is based on the work of a multidisciplinary expert panel that reviews a synthesis of the scientific evidence and rates the appropriateness of a comprehensive list of indications for the procedure being studied. Previous studies, however, have all involved single-country panels. We tested the feasibility of carrying out a multinational panel to rate the appropriateness and necessity of coronary revascularization, thereby producing recommendations for common European criteria.
Using the RAND methodology, a multispecialty (interventional cardiologists, non-interventional cardiologists and cardiovascular surgeons), multinational (The Netherlands, Spain, Sweden, Switzerland and the United Kingdom) panel rated the appropriateness and necessity of indications for percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass graft surgery (CABG). A synthesis of the evidence and list of indications for PTCA and CABG were sent to 15 panelists, three from each country, who performed their ratings in three rounds.
For PTCA, 24% of the indications were appropriate and necessary, 16% were appropriate, 43% were uncertain and 17% were inappropriate. The corresponding values for CABG were 33% appropriate and necessary, 7% appropriate, 40% uncertain and 20% inappropriate. The proportion of indications rated with disagreement was 4% for PTCA and 7% for CABG.
Multinational panels appear to be a feasible method of addressing issues concerning the appropriateness and necessity of medical procedures in western European countries. The criteria produced provide a common tool that can be used to measure the overuse and underuse of medical procedures and to guide decision-making.
冠状动脉血运重建术的使用存在很大差异，这使得许多国家采用兰德适宜性方法来制定具体标准，以描述适合接受这些手术的患者。该方法基于一个多学科专家小组的工作，该小组审查科学证据的综合情况，并对所研究手术的全面适应症列表的适宜性进行评级。然而，以往的研究都只涉及单一国家的专家小组。我们测试了组建一个跨国专家小组来评估冠状动脉血运重建术的适宜性和必要性的可行性，从而为欧洲通用标准提出建议。
采用兰德方法，一个多专业（介入心脏病学家、非介入心脏病学家和心血管外科医生）、跨国（荷兰、西班牙、瑞典、瑞士和英国）的专家小组对经皮冠状动脉腔内血管成形术（PTCA）和冠状动脉旁路移植术（CABG）适应症的适宜性和必要性进行了评级。PTCA和CABG的证据综合情况及适应症列表被发送给15名专家小组成员，每个国家3名，他们分三轮进行评级。
对于PTCA，24%的适应症是适宜且必要的，16%是适宜的，43%不确定，17%是不适宜的。CABG的相应数值分别为33%适宜且必要、7%适宜、40%不确定和20%不适宜。PTCA评级存在分歧的适应症比例为4%，CABG为7%。
跨国专家小组似乎是解决西欧国家医疗程序适宜性和必要性问题的一种可行方法。所制定的标准提供了一个通用工具，可用于衡量医疗程序的过度使用和使用不足情况，并指导决策。
