Multiattribute utility scores for predicting family physicians' decisions regarding sinusitis

To examine whether multiattribute utility (MAU) scores can be used to predi ct family physicians' decisions regarding patients suspected to have sinusi tis and rhinitis, 100 randomly selected family physicians from the Leiden a rea (The Netherlands) were asked to rank a set of six attributes regarding their importance, yielding attribute weights. Next, the physicians were ask ed to rate the degrees to which five decision alternatives optimized each a ttribute, yielding utilities, regarding three case vignettes about a patien t suspected to have acute maxillary sinusitis and rhinitis, with a brief cl inical history. By combining attribute weights and utilities, a MAU score w as calculated for each decision alternative regarding each case vignette. F inally, for each case vignette the physicians' treatment preferences were a ssessed by means of an open-ended question. For the clear-cut sinusitis cas e, management strategies and highest MAU scores were concordant for 80% of the physicians. Regarding the dubious sinusitis and rhinitis case, concorda nce was 50%. The latter was associated with small differences in values bet ween the highest MAU scores. Because agreement among the physicians regardi ng the management strategies and weight ranks was high and there was little variation in the highest MAU scores, the kappas between the reported manag ement strategies and weight ranks were poor (0.24 and lower). It is conclud ed that MAU scores may be used to predict family physicians' decisions rega rding the management of patients suspected of having sinusitis where there are significant differences in values between the highest MAU scores.