Brook R H, Kosecoff J B, Park R E, Chassin M R, Winslow C M, Hampton J R
Health Program of The RAND Corporation, Santa Monica, California.
Lancet. 1988 Apr 2;1(8588):750-3. doi: 10.1016/s0140-6736(88)91550-4.
Two panels of doctors, one in the USA and one in the UK, were asked to indicate how appropriate they judged a series of possible indications for coronary angiography and coronary artery bypass graft (CABG) operations. "Appropriateness" was defined with respect to possible benefit to the patient and excluded considerations of cost. The indications were presented as a series of detailed clinical situations in which the procedure might be used, and for each indication individual panel members rated appropriateness on a scale of 1 to 9. The US panel judged more indications appropriate than did the UK panel, and there was more agreement among the members of the US panel than among those of the UK panel. Although the two panels tended to rate the appropriateness of the indications in the same order, the UK panel placed more emphasis than did the US panel on the importance of symptoms and the amount of medical treatment. Application of the panels' ratings to two groups of patients who had had coronary angiography showed that 17% and 27% of the investigations had been inappropriate by the standards of the US panel, whereas 42% and 60% were inappropriate by the UK panel ratings. 13% of the CABG operations studied were inappropriate by the US and 35% by the UK panel ratings.
两组医生，一组来自美国，一组来自英国，被要求指出他们认为一系列冠状动脉造影和冠状动脉旁路移植术（CABG）手术的可能适应症的合适程度。“合适程度”是根据对患者可能的益处来定义的，不考虑成本因素。这些适应症以一系列可能使用该手术的详细临床情况呈现，对于每个适应症，小组中的个体成员按照1至9的等级对合适程度进行评分。美国小组认为合适的适应症比英国小组更多，并且美国小组成员之间的意见比英国小组成员之间的意见更一致。尽管两个小组倾向于以相同的顺序对适应症的合适程度进行评分，但英国小组比美国小组更强调症状的重要性和医疗治疗的量。将小组的评分应用于两组接受过冠状动脉造影的患者，结果显示，按照美国小组的标准，分别有17%和27%的检查是不合适的，而按照英国小组的评分，这一比例分别为42%和60%。按照美国小组的评分，所研究的CABG手术中有13%是不合适的，按照英国小组的评分则为35%。
