SETTING STANDARDS FOR EFFECTIVENESS - A COMPARISON OF EXPERT PANELS AND DECISION-ANALYSIS

Objective: To compare criteria for coronary revascularization develope d by the expert panel process and by decision analysis. Method: We rev iewed the medical records of 3080 chronic stable angina patients who e ither underwent coronary artery bypass graft surgery (CABG) or percuta neous transluminal coronary angioplasty (PTCA) and determined the agre ement between appropriateness ratings made by two expert physician pan els, one from the United States and the second from The Netherlands, W e also evaluated the agreement between these panels' appropriateness r atings and a decision analytic model's effectiveness categories. Resul ts: There was poor agreement between U,S, and Dutch panel appropriaten ess ratings for PTCA (kappa=0.03) and slight agreement for bypass surg ery (kappa=0.18). Dutch ratings had substantial agreement with the dec ision analytic model's effectiveness categories for both PTCA and CABG (kappa=0.83 and 0.79, respectively) whereas there was no systematic a greement between U.S. ratings and the decision analytic model for PTCA and poor agreement for CABG (kappa=0.00 and 0.18, respectively). Conc lusions: Although the level of agreement between expert panels and dec ision analysis on when a procedure is appropriate or effective may var y by procedure and the strength of the scientific evidence, we found t hat Dutch physicians agree much more strongly with decision analysis t han U.S. physicians. (C) 1997 Elsevier Science Ltd.