Concordance of Physician Ratings With the Appropriate Use Criteria for Coronary Revascularization

被引：22

作者：

Chan, Paul S. ^{[1
,2
]}

Brindis, Ralph G. ^{[3
,4
]}

Cohen, David J. ^{[1
,2
]}

Jones, Philip G. ^{[1
]}

Gialde, Elizabeth ^{[1
]}

Bach, Richard G. ^{[4
,5
]}

Curtis, Jeptha ^{[6
]}

Bethea, Charles F. ^{[7
]}

Shelton, Marc E. ^{[8
]}

Spertus, John A. ^{[1
,2
]}

机构：

[1] St Lukes Mid Amer Heart Inst, Kansas City, MO 64111 USA

[2] Univ Missouri, Kansas City, MO 64110 USA

[3] No Calif Kaiser Permanente Univ Calif, Oakland, CA USA

[4] Amer Coll Cardiol, Washington, DC USA

[5] Washington Univ, Sch Med, Barnes Jewish Hosp, St Louis, MO USA

[6] Yale Univ, Sch Med, New Haven, CT USA

[7] Univ Oklahoma, INTEGRIS Baptist Med Ctr, Sch Med, Oklahoma City, OK USA

[8] So Illinois Univ, Sch Med, Prairie Heart Inst, St Johns Hosp, Springfield, IL USA

来源：

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY | 2011年 / 57卷 / 14期

关键词：

angioplasty; appropriateness; coronary revascularization;

D O I：

10.1016/j.jacc.2010.10.050

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Objectives The objective of this study was to compare the consistency in appropriate use criteria (AUC) ratings among a broad range of practicing cardiologists and the AUC Technical Panel. Background AUC for coronary revascularization have been developed by selected experts. Methods Before AUC publication, 85 cardiologists from 10 U.S. institutions assessed the appropriateness of coronary revascularization for 68 indications that had been evaluated by the AUC Technical Panel. Each indication was classified as appropriate, uncertain, or inappropriate, based on the physician group's median rating. Rates of concordance between the physician group and the AUC Technical Panel (i.e., same appropriateness category assignment) and rates of nonagreement within the physician group (>= 25% of panelists' ratings outside the group's appropriateness category assessment) were determined. Results Overall concordance between the 2 groups was 84%. Among indications classified as appropriate by the AUC Technical Panel, concordance between the 2 groups was excellent (94% [34 of 36]); however, nonagreement within the physician group was 44% (16 of 36). Among indications classified as uncertain, there was 73% (16 of 22) concordance between the 2 groups. Among inappropriate indications, concordance was moderate (70% [7 of 10]), but nonagreement occurred frequently (70% [7 of 10]). Moreover, there was substantial variation in appropriateness ratings between individual physicians and the AUC Technical Panel (weighted kappa range: 0.05 to 0.76). Conclusions Although there was good concordance in assessments of appropriateness for coronary revascularization between physicians and the AUC Technical Panel, nonagreement within the physician group was common and there was marked variation in ratings between individual physicians and the AUC Technical Panel. (J Am Coll Cardiol 2011;57:1546-53) (c) 2011 by the American College of Cardiology Foundation

引用

页码：1546 / 1553

页数：8

共 2 条

[1]

Fitch K., 2001, The RAND/UCLA appropriateness method user's manual

[2] ACCF/SCAI/STS/AATS/AHA/ASNC 2009 Appropriateness Criteria for Coronary Revascularization [J].

Patel, Manesh R. ;

Dehmer, Gregory J. ;

Hirshfeld, John W. ;

Smith, Peter K. ;

Spertus, John A. .

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2009, 53 (06) :530-553

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