Bernstein S J, Lázaro P, Fitch K, Aguilar M D, Kahan J P
Health Services Research Unit, Instituto de Salud Carlos III, Madrid, Spain.
Med Care. 2001 May;39(5):513-20. doi: 10.1097/00005650-200105000-00011.
Appropriateness criteria are frequently used to assess quality of care. However, assessing care in one country with criteria developed in another may be misleading. One approach to measuring care across countries would be to develop common standards using physicians from different countries and specialties.
To identify the degree to which appropriateness ratings for coronary revascularization developed by a multinational panel differ by panelist specialty and nationality.
A 13-member panel of cardiothoracic surgeons and cardiologists from the Netherlands, Spain, Sweden, Switzerland, and the United Kingdom was convened to rate the appropriateness of 842 indications for percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass graft surgery (CABG) on a 1 (extremely inappropriate) to 9 (extremely appropriate) scale.
Mean appropriateness ratings by panelist specialty and nationality.
Surgeons' mean ratings for PTCA indications ranged from 0.64 points lower than the corresponding ratings of the cardiologists for acute myocardial infarction indications to 1.22 points lower for chronic stable angina indications. Conversely, their ratings for bypass surgery indications ranged from 0.59 points higher for chronic stable angina indications to 0.69 points higher for unstable angina indications. Although Spanish panelists' ratings were significantly higher than the mean for 3 of the 4 clinical conditions treated by PTCA, their ratings were similar for bypass surgery indications. No specific patterns were observed in the ratings of the panelists from the other countries.
These findings support the use of physicians from multiple specialties on appropriateness panels because they represent more divergent views than physicians from a single specialty. Finding no systematic difference in beliefs regarding the appropriateness of PTCA and CABG among physicians from different countries will require confirmation before multinational panels supplant single country panels in future studies.
适宜性标准常被用于评估医疗质量。然而，用在另一个国家制定的标准来评估该国的医疗情况可能会产生误导。一种衡量不同国家医疗情况的方法是利用来自不同国家和专业的医生制定通用标准。
确定一个跨国专家小组对冠状动脉血运重建适宜性的评级在专家专业和国籍方面的差异程度。
召集了一个由来自荷兰、西班牙、瑞典、瑞士和英国的心胸外科医生和心脏病专家组成 的13人专家小组，对842例经皮腔内冠状动脉成形术（PTCA）和冠状动脉旁路移植术（CABG）适应症的适宜性按照1（极不适当）至9（极为适当）的量表进行评分。
按专家专业和国籍划分的平均适宜性评分。
外科医生对PTCA适应症的平均评分比心脏病专家对急性心肌梗死适应症的相应评分低0.64分，对慢性稳定型心绞痛适应症的评分低1.22分。相反，他们对搭桥手术适应症的评分，对慢性稳定型心绞痛适应症高0.59分，对不稳定型心绞痛适应症高0.69分。尽管西班牙专家对PTCA治疗的4种临床情况中的3种的评分明显高于平均分，但他们对搭桥手术适应症的评分相似。在其他国家专家的评分中未观察到特定模式。
这些发现支持在适宜性专家小组中使用来自多个专业的医生，因为他们比来自单一专业的医生代表了更多不同的观点。在未来的研究中，跨国专家小组取代单一国家专家小组之前，需要确认不同国家的医生在PTCA和CABG适宜性方面的信念没有系统差异。
