Jp. Vader et al., APPROPRIATENESS OF UPPER GASTROINTESTINAL ENDOSCOPY - COMPARISON OF AMERICAN AND SWISS CRITERIA, International journal for quality in health care, 9(2), 1997, pp. 87-92
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.