医生评分与冠状动脉血运重建适当使用标准的一致性。

Concordance of physician ratings with the appropriate use criteria for coronary revascularization.

机构信息

Saint Luke's Mid America Heart Institute, Kansas City, Missouri 64111, USA.

出版信息

J Am Coll Cardiol. 2011 Apr 5;57(14):1546-53. doi: 10.1016/j.jacc.2010.10.050.

DOI:10.1016/j.jacc.2010.10.050

PMID:21453833

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3085030/

Abstract

OBJECTIVES

The objective of this study was to compare the consistency in appropriate use criteria (AUC) ratings among a broad range of practicing cardiologists and the AUC Technical Panel.

BACKGROUND

AUC for coronary revascularization have been developed by selected experts.

METHODS

Before AUC publication, 85 cardiologists from 10 U.S. institutions assessed the appropriateness of coronary revascularization for 68 indications that had been evaluated by the AUC Technical Panel. Each indication was classified as appropriate, uncertain, or inappropriate, based on the physician group's median rating. Rates of concordance between the physician group and the AUC Technical Panel (i.e., same appropriateness category assignment) and rates of nonagreement within the physician group (≥ 25% of panelists' ratings outside the group's appropriateness category assessment) were determined.

RESULTS

Overall concordance between the 2 groups was 84%. Among indications classified as appropriate by the AUC Technical Panel, concordance between the 2 groups was excellent (94% [34 of 36]); however, nonagreement within the physician group was 44% (16 of 36). Among indications classified as uncertain, there was 73% (16 of 22) concordance between the 2 groups. Among inappropriate indications, concordance was moderate (70% [7 of 10]), but nonagreement occurred frequently (70% [7 of 10]). Moreover, there was substantial variation in appropriateness ratings between individual physicians and the AUC Technical Panel (weighted kappa range: 0.05 to 0.76).

CONCLUSIONS

Although there was good concordance in assessments of appropriateness for coronary revascularization between physicians and the AUC Technical Panel, nonagreement within the physician group was common and there was marked variation in ratings between individual physicians and the AUC Technical Panel.

摘要

目的

本研究旨在比较广泛范围内的执业心脏病专家和 AUC 技术专家组在适当使用标准（AUC）评分方面的一致性。

背景

AUC 用于冠状动脉血运重建是由选定的专家制定的。

方法

在 AUC 公布之前，来自美国 10 个机构的 85 名心脏病专家根据 AUC 技术专家组评估的 68 种适应证评估了冠状动脉血运重建的适当性。根据医生组的中位数评分，将每个适应证分为适当、不确定或不适当。确定医生组与 AUC 技术专家组之间的一致性率（即相同的适宜性类别分配）和医生组内的不一致率（≥25%的小组成员评分超出小组的适宜性类别评估）。

结果

两组之间的总体一致性为 84%。在 AUC 技术专家组分类为适当的适应证中，两组之间的一致性极好（94%[34/36]）；然而，医生组内的不一致率为 44%（36/36）。在分类为不确定的适应证中，两组之间有 73%（16/22）的一致性。在不适当的适应证中，一致性适中（70%[7/10]），但经常出现不一致（70%[7/10]）。此外，个别医生和 AUC 技术专家组之间的适宜性评分存在很大差异（加权 kappa 范围：0.05 至 0.76）。