Kahan J P, Park R E, Leape L L, Bernstein S J, Hilborne L H, Parker L, Kamberg C J, Ballard D J, Brook R H
Department of Health Policy and Management, Harvard School of Public Health, Boston, MA, USA.
Med Care. 1996 Jun;34(6):512-23. doi: 10.1097/00005650-199606000-00002.
The authors compare the appropriateness ratings and mutual influence of panelists from different specialties rating a comprehensive set of indications for six surgical procedures. Nine-member panels rated each procedure: abdominal aortic aneurysm surgery, carotid endarterectomy, cataract surgery, coronary angiography, and coronary artery bypass graft surgery/percutaneous transluminal coronary angioplasty (common panel). Panelists individually rated the appropriateness of indications at home and then discussed and re-rated the indications during a 2-day meeting. Subsequently, they rated the necessity of those indications scored by the group as appropriate. There were 45 panelists, including specialists (either performers of the procedure or members of a related specialty) and primary care providers, all drawn from nominations by their respective specialty societies. Main outcome measures included: individual panelists' mean ratings over all indications, mean change and conformity scores between rounds of ratings, and the percentage of audited actual procedures rated appropriate or necessary. Performers had the highest mean ratings, followed by physicians in related specialties, trailed by primary care providers. One fifth of all actual procedures were for indications rated appropriate by performers and less than appropriate by primary care providers. At the panel meetings, primary care providers and related specialists showed no greater tendency to be influenced by other panelists than did performers. Multispecialty panels provide more divergent viewpoints than panels composed entirely of performers. This divergence means that fewer actual procedures are deemed performed for appropriate or necessary indications.
作者比较了来自不同专业的专家小组对六种外科手术的一系列综合适应症的适宜性评级及相互影响。九个成员的小组对每种手术进行评级：腹主动脉瘤手术、颈动脉内膜切除术、白内障手术、冠状动脉造影以及冠状动脉搭桥手术/经皮腔内冠状动脉成形术（共同小组）。小组成员先在家中单独对适应症的适宜性进行评级，然后在为期两天的会议中进行讨论并重新评级。随后，他们对小组评定为适宜的那些适应症的必要性进行评级。共有45名小组成员，包括专家（手术执行者或相关专业的成员）和初级保健提供者，均来自各自专业协会的提名。主要结果指标包括：所有适应症上个体小组成员的平均评级、各轮评级之间的平均变化和一致性得分，以及经审核的实际手术中评定为适宜或必要的百分比。手术执行者的平均评级最高，其次是相关专业的医生，初级保健提供者排在最后。所有实际手术中有五分之一的适应症，手术执行者评定为适宜，而初级保健提供者评定为不太适宜。在小组会议上，初级保健提供者和相关专家受到其他小组成员影响的倾向并不比手术执行者更大。多专业小组比完全由手术执行者组成的小组提供了更多不同的观点。这种差异意味着被认为是出于适宜或必要适应症而进行的实际手术更少。
