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Panellist consistency in the assessment of medical appropriateness
J McDonnell1, A Meijler, J P Kahan
1Institute for Medical Technology Assessment, Erasmus University, Rotterdam, Netherlands.
Insights
Expert panels established guidelines for coronary angioplasty and bypass graft surgery appropriateness. The modified Delphi process showed increased agreement and logical, consistent ratings among specialists.
Area of Science:
- Cardiology
- Health Services Research
- Medical Guidelines
Background:
- Establishing guidelines for surgical procedure appropriateness is crucial when data is limited.
- Expert panels are a recognized method for developing clinical practice guidelines.
Purpose of the Study:
- To assess the appropriateness of percutaneous transluminal coronary angioplasty and coronary artery bypass graft surgery in the Netherlands.
- To evaluate the consensus-building process and consistency of expert panel ratings.
Main Methods:
- A modified Delphi process was employed by a panel of interventional cardiologists and cardiothoracic surgeons.
- 1126 clinical indications were rated over two rounds to assess appropriateness.
- Analysis focused on changes in member agreement, appropriateness ratings, and internal consistency.
Main Results:
- Panel member agreement increased significantly over the two rounds.
- Most appropriateness ratings remained stable, with notable shifts from equivocal to determinate ratings.
- Individual panellist scoring showed some inconsistency, but the panel as a whole demonstrated high consistency.
Conclusions:
- The modified Delphi process effectively facilitated consensus on the appropriateness of coronary revascularization procedures.
- The observed changes and consistency indicate the method is applied logically and reliably by expert panels.
- This study supports the use of expert panels for guideline development in areas with limited evidence.
Abstract:
Where information about the appropriateness of a surgical procedure is lacking, expert panels have been used to establish guidelines for medical practitioners. Such a panel was convened to assess the appropriateness of percutaneous transluminal coronary angioplasty and coronary artery bypass graft surgery in the Netherlands. The panel, consisting of interventional cardiologists and cardiothoracic surgeons, used a modified Delphi process to rate 1126 clinical indications over two rounds. This article describes the degree of change in both agreement amongst members and in the appropriateness ratings over the two rounds, and examines the internal consistency of the ratings of individual panellists. Over the two rounds, agreement increased. Although most appropriateness ratings remained unchanged, there was significant movement from equivocal ratings to determinate ratings. While individual members showed some degree of inconsistency in their scoring, the panel as a whole scored very consistently. The observed changes in appropriateness were consistent with expectations, showing that the appropriateness method is used logically and consistently by panellists.