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Placing patients in the queue for coronary revascularization: evidence for practice variations from an expert panel
C D Naylor1, A Basinski, R S Baigrie
1Sunnybrook Health Science Center, North York, Ontario, Canada.
American Journal of Public Health
|October 1, 1990
Summary
Cardiologists showed low consensus on revascularization timing. Standardized criteria are needed for fair and consistent patient triage, improving treatment priorities.
Area of Science:
- Cardiology
- Cardiac Surgery
- Health Services Research
Background:
- Assessing optimal timing for revascularization is complex.
- Variability in clinical judgment can impact patient outcomes.
Purpose of the Study:
- To evaluate expert consensus on maximum acceptable delays for revascularization.
- To identify factors influencing revascularization timing decisions.
Main Methods:
- 16 cardiologists and cardiac surgeons rated 438 case scenarios.
- Used a 7-point scale for interventional time frames and nodes for inappropriate cases.
- Defined consensus as agreement by 12 or more panelists.
Main Results:
- Only 1.4% of scenarios reached consensus on a single rating with 12+ panelists.
- 59.4% reached consensus within broad clinical categories (prompt, wait, no intervention) with 12+ panelists.
- Clinical features, not individual panelists, were stronger predictors of urgency.
Conclusions:
- Significant variability exists in expert opinion on revascularization timing.
- Need for consensus criteria to ensure consistent and fair triage practices.
- Standardized approaches to revascularization priorities may be feasible and beneficial.