APPROPRIATENESS OF UPPER GASTROINTESTINAL ENDOSCOPY - COMPARISON OF AMERICAN AND SWISS CRITERIA

Objective: Examine the reproducibility of the RAND method for developi ng criteria for the appropriateness of medical procedures. Design: Com parison of two sets of explicit criteria for appropriateness of upper gastrointestinal (UGI) endoscopy, developed by separate expert panels from two countries. Setting: United States, Switzerland. Study partici pants: National experts from different medical specialties involved in the referral or application of UGI endoscopy. Interventions: Each pan el was presented with about 500 clinical scenarios (indications) that were rated on a nine-point scale as to the appropriateness of performi ng UGI endoscopy for a patient with that clinical presentation. Main o utcome measures: (1) distribution of appropriateness ratings and intra panel agreement categories between the two panels, (2) between-panel a greement of assigning appropriateness for comparable indications and, (3) percentage of indications with major between-panel differences. Re sults: Ratings for 2/3 of indications could be compared. The Swiss pan el showed higher intrapanel agreement (54.6% versus 46.2%, P=0.002). S eventy-eight per cent of comparable indications were assigned to ident ical categories of appropriateness by both panels (kappa=0.76, P <0.00 1). For 93% of the 376 comparable indications, there were no major int erpanel differences. Conclusion: Separate expert panels in different c ountries, using a standardized methodology, produce criteria for appro priateness of medical procedures that are similar. Given the resources being invested throughout the world in developing criteria and guidel ines, international collaboration in seeking optimal use of limited he alth care resources should be intensified. (C) 1997 Elsevier Science L td.