Bernstein S J, Hofer T P, Meijler A P, Rigter H
Department of Medicine, University of Michigan, Ann Arbor 48109-0376, USA.
Int J Qual Health Care. 1997 Aug;9(4):255-63. doi: 10.1093/intqhc/9.4.255.
To compare criteria for coronary revascularization developed by the expert panel process and by decision analysis.
We reviewed the medical records of 3080 chronic stable angina patients who either underwent coronary artery bypass graft surgery (CABG) or percutaneous transluminal coronary angioplasty (PTCA) and determined the agreement between appropriateness ratings made by two expert physician panels, one from the United States and the second from The Netherlands. We also evaluated the agreement between these panels' appropriateness ratings and a decision analytic model's effectiveness categories.
There was poor agreement between U.S. and Dutch panel appropriateness ratings for PTCA (kappa = 0.03) and slight agreement for bypass surgery (kappa = 0.18). Dutch ratings had substantial agreement with the decision analytic models effectiveness categories for both PTCA and CABG (kappa = 0.83 and 0.79, respectively) whereas there was no systematic agreement between U.S. ratings and the decision analytic model for PTCA and poor agreement for CABG (kappa = 0.00 and 0.18, respectively).
Although the level of agreement between expert panels and decision analysis on when a procedure is appropriate or effective may vary by procedure and the strength of the scientific evidence, we found that Dutch physicians agree much more strongly with decision analysis than U.S. physicians.
比较通过专家小组程序和决策分析制定的冠状动脉血运重建标准。
我们回顾了3080例慢性稳定型心绞痛患者的病历，这些患者要么接受了冠状动脉旁路移植术（CABG），要么接受了经皮腔内冠状动脉成形术（PTCA），并确定了两个专家医师小组（一个来自美国，另一个来自荷兰）做出的适宜性评级之间的一致性。我们还评估了这些小组的适宜性评级与决策分析模型的有效性类别之间的一致性。
美国和荷兰小组对PTCA的适宜性评级之间一致性较差（kappa = 0.03），对搭桥手术的一致性为轻微（kappa = 0.18）。荷兰的评级与PTCA和CABG的决策分析模型有效性类别有实质性一致性（分别为kappa = 0.83和0.79），而美国的评级与PTCA的决策分析模型之间没有系统的一致性，与CABG的一致性较差（分别为kappa = 0.00和0.18）。
尽管专家小组和决策分析在何时一项手术适宜或有效方面的一致程度可能因手术和科学证据的强度而异，但我们发现荷兰医生比美国医生更认同决策分析。
