Effect of specialty and nationality on panel judgments of the appropriateness of coronary revascularization: A pilot study

BACKGROUND, Appropriateness criteria are frequently used to assess quality of care. However, assessing care in one country with criteria developed in another may be misleading. One approach to measuring care across countries would be to develop common standards using physicians from different countr ies and specialties. OBJECTIVE. To identify the degree to which appropriateness ratings for coro nary revascularization developed by a multinational panel differ by panelis t specialty and nationality. METHODS. A 13-member panel of cardiothoracic surgeons and cardiologists fro m the Netherlands, Spain, Sweden, Switzerland, and the United Kingdom was c onvened to rate the appropriateness of 842 indications for percutaneous tra nsluminal coronary angioplasty (PTCA) and coronary artery bypass graft surg ery (CABG) on al(extremely inappropriate) to 9 (extremely appropriate) scal e. MEASURES. Mean appropriateness ratings by panelist specialty and nationalit y. RESULTs. Surgeons' mean ratings for PTCA indications ranged from 0.64 point s lower than the corresponding ratings of the cardiologists for acute myoca rdial infarction indications to 1.22 points lower for chronic stable angina indications. Conversely, their ratings for bypass surgery indications rang ed from 0.59 points higher for chronic stable angina indications to 0.69 po ints higher for unstable angina indications, Although Spanish panelists' ra tings were significantly higher than the mean for 3 of the 4 clinical condi tions treated by PTCA, their ratings were similar for bypass surgery indica tions. No specific patterns were observed in the ratings of the panelists f rom the other countries, CONCLUSIONS. These findings support the use of physicians from multiple spe cialties on appropriateness panels because they represent more divergent vi ews than physicians from a single specialty. Finding no systematic differen ce in beliefs regarding the appropriateness of PTCA and CABG among physicia ns from different countries will require confirmation before multinational panels supplant single country panels in future studies.