European criteria for the appropriateness and necessity of coronary revascularization procedures
European criteria for the appropriateness and necessity of coronary revascularization procedures
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DOI：
10.1016/s1010-7940(00)00530-3
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发表时间：
2000-10-01
影响因子：
3.4
通讯作者：
Bernstein, SJ
中科院分区：
文献类型：
--
作者：
Fitch, K;L치zaro, P;Bernstein, SJ
目的：冠状动脉血运重建手术的使用存在巨大差异，导致许多国家应用 RAND 适当性方法来制定描述应接受这些手术的患者的具体标准。该方法基于多学科专家小组的工作，该专家小组审查科学证据的综合，并评估正在研究的程序的综合适应症列表的适当性。然而，之前的研究都涉及单一国家小组。我们测试了进行多国小组评估冠状动脉血运重建的适当性和必要性的可行性，从而为欧洲共同标准提出建议。方法：使用兰德方法论，多专业（介入心脏病学家、非介入心脏病学家和心血管外科医生）、多国（荷兰、西班牙、瑞典、瑞士和英国）专家小组对经皮腔内冠状动脉成形术（PTCA）和冠状动脉搭桥手术（CABG）适应症的适当性和必要性进行了评估。 PTCA 和 CABG 的证据综合和适应症清单已发送给 15 名小组成员（每个国家 3 名），他们分三轮进行评级。结果：对于PTCA，24%的适应症是适当和必要的，16%是适当的，43%是不确定的，17%是不适当的。 CABG 的相应值是 33% 是适当和必要的，7% 是适当的，40% 是不确定的，20% 是不适当的。 PTCA 中被评为不一致的适应症比例为 4%，CABG 中为 7%。结论：多国专家组似乎是解决西欧国家医疗程序的适当性和必要性问题的可行方法。制定的标准提供了一个通用工具，可用于衡量医疗程序的过度使用和未充分使用并指导决策。 (C) 2000 Elsevier Science B.V. 保留所有权利。
Objectives: Large variations in the use of coronary revascularization procedures have led many countries to apply the RAND appropriateness method to develop specific criteria describing patients who should be offered these procedures. The method is based on the work of a multidisciplinary expert panel that reviews a synthesis of the scientific evidence and rates the appropriateness of a comprehensive list of indications for the procedure being studied. Previous studies, however, have all involved single-country panels. We tested the feasibility of carrying out a multinational panel to rate the appropriateness and necessity of coronary revascularization, thereby producing recommendations for common European criteria. Methods: Using the RAND methodology, a multispecialty (interventional cardiologists, non-interventional cardiologists and cardiovascular surgeons), multinational (The Netherlands, Spain, Sweden, Switzerland and the United Kingdom) panel rated the appropriateness and necessity of indications for percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass graft surgery (CABG). A synthesis of the evidence and list of indications for PTCA and CABG were sent to 15 panelists, three from each country, who performed their ratings in three rounds. Results: For PTCA, 24% of the indications were appropriate and necessary, 16% were appropriate, 43% were uncertain and 17% were inappropriate. The corresponding values for CABG were 33% appropriate and necessary, 7% appropriate, 40% uncertain and 20% inappropriate. The proportion of indications rated with disagreement was 4% for PTCA and 7% for CABG. Conclusion: Multinational panels appear to be a feasible method of addressing issues concerning the appropriateness and necessity of medical procedures in western European countries. The criteria produced provide a common tool that can he used to measure the overuse and underuse of medical procedures and to guide decision-making. (C) 2000 Elsevier Science B.V. All rights reserved.