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Developing criteria for cesarean section using the RAND appropriateness method
Rahim Ostovar1, Arash Rashidian, Abolghasem Pourreza
1Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Iran.
BMC Pregnancy and Childbirth
|September 16, 2010
Summary
Cesarean section appropriateness criteria were identified using the RAND Appropriateness Method (RAM). Expert panel consensus revealed disagreements with evidence, potentially explaining rising cesarean rates.
Area of Science:
- Obstetrics and Gynecology
- Health Services Research
Background:
- Global increase in cesarean section (CS) rates, with a notable rise in Iran.
- Clinical disagreement on appropriate indications for CS.
- Need to establish clear appropriateness criteria for CS in Iran.
Framework:
- Utilized a modified RAND Appropriateness Method (RAM) for consensus development.
- Generated clinical scenarios from existing guidelines and expert opinions.
- Employed a multi-round Delphi-like process with expert panels.
Implementation:
- A panel of 12 experts initially participated via mail, followed by 9 experts in a face-to-face meeting.
- Developed 294 unique scenarios related to CS indications.
- Applied RAM protocols for scenario generation, rating scales, and statistical analysis.
Implications:
- RAM effectively identified stakeholder views on CS appropriateness, even in resource-limited settings.
- Significant discrepancies noted between expert panel opinions and existing evidence for certain CS indications.
- Lack of consensus on numerous scenarios may contribute to the persistent rise in CS rates.
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