New Zealand and United Kingdom experiences with the RAND modified Delphi approach to producing angina and heart failure criteria for quality assessment in general practice

Objectives-(1) To describe the development of minimum review criteria for t he general practice management in New Zealand (NZ) of two chronic diseases: stable angina and systolic heart failure, and (2) to compare the NZ angina criteria with a set produced in Manchester to assess the extent to which u se of the same approach to criteria development yields similar criteria. Methods-A modified Delphi approach, based on the RAND consensus panel metho d, was used to produce minimum criteria for reviewing the recorded manageme nt of heart failure and angina in NZ general practice. The criteria for ang ina were compared with those produced in the UR, including assessment of th e extent to which each set describes actions that the other panel agrees ar e necessary to record. Results-For each condition we report minimum criteria describing actions ra ted as (a) necessary to record and (b) inappropriate to take but, if taken, necessary to record. Although strong scientific evidence underpins approxi mately one quarter and one third, respectively; of the final sets of NZ and UK angina criteria for actions necessary to record, the NZ criteria agree strongly with the UK criteria (33 of 39 criteria, 85%) but there is less UK agreement with the NZ angina criteria (28 of 40 criteria, 70%). Conclusion-Despite the lack of scientific evidence for up to three quarters of angina care in general practice, the RAND based approach to criteria de velopment was used in NZ to reproduce most of the UK angina criteria for ac tions rated as necessary to record in general practice. It is important to make explicit whether ratings of necessity and appropriateness apply to the recording of actions or to the actions themselves.