Using data to enhance the expert panel process - Rating indications of alcohol-related problems in older adults

Objective: To enhance the validity of a well-known expert panel process, we used data from patient surveys to identify and correct rating errors. Methods: We used the two-round RAND/UCLA panel method to rate indications o f harmful (presence of problems), hazardous (at risk for problems), and non hazardous (no known risks) drinking in older adults. Results from the panel provided guidelines for classifying older individuals as harmful, hazardou s, or nonhazardous drinkers, using a survey. The classifications yielded un expectedly high numbers of harmful and hazardous drinkers. We hypothesized possible misclassifications of drinking risks and used the survey data to i dentify indications that may have led to invalid ratings. We modified probl ematic indications and asked three clinician panelists to evaluate the clin ical usefulness of the modifications in a third panel round. We revised the indications based on panelist response and reexamined drinking classificat ions. Results: Using the original indications, 48% of drinkers in the sample were classified as harmful, 31% as hazardous, and 21% as nonhazardous. A review of the indications revealed framing bias in the original rating task and v ague definitions of certain symptoms and conditions. The modified indicatio ns resulted in classifications of 22% harmful, 47% hazardous, and 31% nonha zardous drinkers. Conclusions: Analysis of survey data led to identification and correction o f specific errors occurring during the panel-rating process. The validity o f the RAND/UCLA method can be enhanced using data-driven modifications.