Maynard C, Fisher L, Alderman E L, Mock M B, Ringqvist I, Bourassa M G, Kaiser G C, Gillespie M J
Med Decis Making. 1986 Jul-Sep;6(3):127-35. doi: 10.1177/0272989X8600600301.
This article examines institutional differences in therapeutic decision making in the Coronary Artery Surgery Study (CASS). The initial decision to use medical therapy or coronary artery bypass surgery for coronary artery disease is studied. Data from the CASS registry and a survey of CASS principal investigators were used to examine the effects of institutional characteristics, individual physician characteristics, and decision making responsibility on the recommended therapy, the actual therapy, and the ratio of the observed to expected number of surgeries. The results indicated that the experience and involvement of the surgeon in the decision making process were related to actual and recommended rates of surgery. The percentage of urgent transfers from other hospitals and the percentage of surgical referrals to outside hospitals were related to the ratio of the observed to expected numbers of surgery, an adjusted rate of surgery. A major conclusion of this study is that despite the effects of certain institutional constructs, scientific criteria in the form of clinical and angiographic data are the most important determinants of whether a patient receives coronary artery bypass surgery.
本文探讨了冠状动脉手术研究（CASS）中治疗决策的机构差异。研究了针对冠状动脉疾病采用药物治疗或冠状动脉搭桥手术的初始决策。来自CASS登记处的数据以及对CASS主要研究者的一项调查被用于检验机构特征、个体医生特征以及决策责任对推荐治疗、实际治疗以及观察到的手术数量与预期手术数量之比的影响。结果表明，外科医生在决策过程中的经验和参与度与实际手术率和推荐手术率相关。来自其他医院的紧急转诊百分比以及转诊至外部医院的手术转诊百分比与观察到的手术数量与预期手术数量之比（调整后的手术率）相关。这项研究的一个主要结论是，尽管某些机构结构有影响，但临床和血管造影数据形式的科学标准是患者是否接受冠状动脉搭桥手术的最重要决定因素。
