Group judgments of appropriateness: the effect of panel composition.
Group judgments of appropriateness: the effect of panel composition.
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小组适当性判断：小组组成的影响。
DOI：
10.1093/oxfordjournals.intqhc.a036710
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发表时间：
1992
期刊：
影响因子：
--
通讯作者：
Robert H. Brook
中科院分区：
文献类型：
--
作者：
Lucian L. Leape;Lucian L. Leape;R. Park;J. Kahan;Robert H. Brook
目前对制定实践指南的兴趣提出了一个重要问题，即专家小组的组成对指南制定过程的结果有何影响。我们比较了两个小组对颈动脉内膜切除术适应症的适当性的评级：一个是全外科小组，另一个是由四名外科医生、两名神经科医生和一名来自家庭医生、内科医生和放射科的专家组成的“平衡”小组。然后，我们比较了两套评级的效果时，用于评估1302例接受颈动脉内膜切除术的患者。全外科小组发现更多的适应症“适当”（24比14%）和更少的适应症“不适当”（61比70%）比平衡小组（p <0.01）。全外科小组也更经常达成一致。当对患者进行评级时，70%的手术符合全手术标准，而38%的手术符合平衡小组标准，而19%的手术不符合全手术标准，而31%的手术符合平衡小组标准。然而，被判定为“不适当且一致”的手术比例在全外科组为15%，在平衡组为16%。我们的结论是，全外科组比多专科组更倾向于颈动脉疾病的手术治疗，但两组对不适当性的一致判断非常相似。
The current interest in the development of practice guidelines raises an important question about the effect of expert panel composition on the outcome of the guideline development process. We compared the ratings of appropriateness of indications for carotid endarterectomy produced by two panels: an all-surgical panel and a "balanced" panel composed of four surgeons, two neurologists, and one specialist each from family practice, internal medicine, and radiology. We then compared the effect of the two sets of ratings when used to evaluate 1302 patients who had undergone carotid endarterectomy. The all-surgical panel found more indications "appropriate" (24 versus 14%) and fewer indications "inappropriate" (61 versus 70%) than the balanced panel (p less than 0.01). The all-surgical panel also more often reached agreement. When ratings were applied to patients, 70% were appropriate by the all-surgical criteria versus 38% by the balanced panel, while 19% of the operations were inappropriate by all-surgical criteria, versus 31% by the balanced panel ratings. However, the percentage of procedures judged "inappropriate with agreement" was 15% for all-surgical and 16% for the balanced panel. We conclude that the all-surgical panel was more likely to favor operative treatment for carotid disease than the multispecialty panel, but that concensus judgments of inappropriateness by the two panels were very similar.