Sutherland L R, Verhoef M J, Meddings J B, Bailey R J, Blustein P B, Lalor E A, Thomson A B, Van Rosendaal G M
Department of Medicine, University of Calgary, Alberta.
Can J Gastroenterol. 1997 Apr;11(3):221-7. doi: 10.1155/1997/295970.
To determine whether endoscopists and general internists agreed with the characterization of appropriateness for endoscopy of various clinical scenarios, as previously reported by the RAND Corporation.
Mail survey.
All endoscopists in western Canada and a random sample of general internists who did not perform endoscopy.
Questionnaires were sent to 179 endoscopists in western Canada who were asked to rate the 53 scenarios for endoscopy on a nine-point scale ranging from most appropriate to most inappropriate. A similar questionnaire was sent to 39 general internists practising in the province of Alberta.
Response rate was 72% of endoscopists (n = 128) and 64% of general internists (n = 25). Among the endoscopists, there was agreement with the RAND classification for 32 scenarios. All 18 indications previously thought to be appropriate were considered to be appropriate. However, endoscopists agreed with only six of 16 equivocal and eight of 19 indications considered inappropriate. Discrepancies were reviewed by five experienced endoscopists and most appeared to be related to a concern regarding possible malignancy linked in part with the definition of failure to respond to medical therapy; and to a refusal to request a barium meal before endoscopy. Among general internists, there was agreement with RAND in 26 scenarios. When the appropriateness rankings of endoscopists and general internists were compared, there was agreement in 40 of 53 scenarios. Significant discrepancies in ratings were identified in scenarios in which barium studies were described as being normal, known or not done.
The equivocal and inappropriate ratings developed by the RAND Corporation are not uniformly accepted by the endoscopy community or general internists. Use of the RAND indications for assessing quality assurance can be challenged.
确定内镜医师和普通内科医师是否认同兰德公司先前报告的各种临床场景下内镜检查适宜性的特征描述。
邮寄调查。
加拿大西部的所有内镜医师以及未进行内镜检查的普通内科医师的随机样本。
向加拿大西部的179名内镜医师发送问卷，要求他们按照从最适宜到最不适宜的九点量表对53种内镜检查场景进行评分。向艾伯塔省执业的39名普通内科医师发送了类似问卷。
内镜医师的回复率为72%（n = 128），普通内科医师的回复率为64%（n = 25）。在内镜医师中，对于32种场景与兰德分类达成了一致。所有先前被认为适宜的18种指征均被视为适宜。然而，内镜医师仅认同16种模棱两可指征中的6种以及19种被认为不适宜指征中的8种。由5名经验丰富的内镜医师对差异进行了审查，大多数差异似乎与对可能恶性肿瘤的担忧有关，部分与对药物治疗无反应的定义有关；以及与在内镜检查前拒绝要求进行钡餐检查有关。在普通内科医师中，对于26种场景与兰德达成了一致。当比较内镜医师和普通内科医师的适宜性排名时，在53种场景中的40种达成了一致。在钡剂造影检查被描述为正常、已知或未进行的场景中发现了评分上的显著差异。
兰德公司制定的模棱两可和不适宜评分未被内镜学界或普通内科医师一致接受。使用兰德指征来评估质量保证可能会受到挑战。
