[Assessment of indications using the RAND method: invasive therapy in coronary sclerosis as an example].

OBJECTIVE

To assess indications for performing medical procedures for their appropriateness, using a method designed by an American research institute, RAND.

DESIGN

Delphi investigation

SETTING

The Netherlands.

METHOD

The RAND method was applied in the 'Dutch inventory of invasive coronary atherosclerosis treatments' study which concerns treatment choices in coronary artery disease: coronary artery bypass grafting (CABG), percutaneous transluminal coronary angioplasty (PTCA) and conservative treatment. Essential in the RAND method is the construction of a comprehensive matrix of potential indications. Each indication entails a comparison of two or three treatment options. A panel of 12 experts rated each indication in a two-stage process. When the majority of the panelists agreed that treatment option X was strongly to be preferred over Y, it was considered appropriate to perform X and inappropriate to perform Y.

RESULTS

The experiences with the RAND method indicated that panelists judged critically and rated many indications for invasive treatment options as inappropriate or uncertain. The method was feasible, although not easy, and produced clinically valid results.

CONCLUSION

The RAND method is especially useful when medical literature does not supply sufficient grounds in rating the appropriateness of an indication for medical procedure. However, the verdict 'appropriate' is not eternal. Medical science keeps evolving.