Development of review criteria for assessing the quality of management of stable angina, adult asthma, and non-insulin dependent diabetes mellitus in, general practice

Objective-To develop review criteria to assess the quality of care for thre e major chronic diseases: adult asthma, stable angina, and non-insulin depe ndent diabetes mellitus. Subjects and Methods-Modified panel process based upon the RAND/UCLA (Unive rsity College of Los Angeles) appropriateness method. Three multiprofession al panels made up of general practitioners, hospital specialists, and pract ice nurses. Results-The RAND/UCLA appropriateness method of augmenting evidence with ex pert opinion was used to develop criteria for the care of the three conditi ons. Of those aspects of care which were rated as necessary by the panels, only 26% (16% asthma, 10% Iron-insulin dependent diabetes, 40% angina) were subsequently rated by the panels as being based on strong scientific evide nce. Conclusion-The results show the importance of a systematic approach to comb ining evidence with expert opinion to develop review criteria for assessing the quality of three chronic diseases in general practice. The evidence ba se for the criteria was often incomplete, and explicit methods need to be u sed to combine evidence with expert opinion where evidence is not available .