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Physician ratings of appropriate indications for three procedures: theoretical indications vs indications used in
Insights
Expert physicians disagree on the appropriateness of medical procedure indications. A study found significant disagreement even for commonly used indications, impacting patient care and decision-making.
Area of Science:
- Medical appropriateness of procedures
- Health services research
- Physician consensus
Background:
- Previous studies revealed significant expert disagreement on the appropriateness of medical and surgical procedures for theoretical indications.
- A gap existed in understanding physician agreement on indications used in actual patient cases.
Purpose of the Study:
- To assess the level of expert physician disagreement on the appropriateness of indications for commonly performed procedures in real-world patient cases.
- To compare disagreement rates for coronary angiography, upper gastrointestinal endoscopy, and carotid endarterectomy.
Main Methods:
- A community-based study analyzed medical records of approximately 4,500 patients undergoing one of three procedures.
- Expert physician panelists rated the appropriateness of indications for these procedures on a 9-point scale.
- Disagreement was defined by excluding extreme ratings and identifying conflicting high and low scores.
Main Results:
- Many theoretical indications for procedures are rarely used in practice.
- Substantial disagreement among experts was found for actual case indications: 5% for coronary angiography, 25% for upper gastrointestinal endoscopy, and 32% for carotid endarterectomy.
- This indicates variability in expert judgment even for established indications.
Conclusions:
- Expert physician disagreement persists regarding the appropriateness of indications for medical procedures, even those used in practice.
- Patients should be aware of this variability in expert opinion when considering procedures like coronary angiography, upper gastrointestinal endoscopy, and carotid endarterectomy.
- Further research is needed to understand the factors contributing to this disagreement and its impact on patient outcomes.
Abstract:
We previously reported substantial disagreement among expert physician panelists about the appropriateness of performing six medical and surgical procedures for a large number of theoretical indications. A recently completed community-based medical records study of about 4,500 patients who had one of three procedures--coronary angiography, upper gastrointestinal endoscopy, and carotid endarterectomy--shows that many of the theoretical indications are seldom or never used in practice. However, we find that there is also substantial disagreement (5, 25, or 32 per cent for angiography, endoscopy, or endarterectomy, respectively) about the appropriateness of indications used in actual cases if disagreement is defined by first discarding the two extreme of nine ratings, then looking for at least one rating near the bottom (1 to 3) and one near the top (7 to 9) of the 9-point scale. Patients should know that a substantial percentage of procedures are performed for indications about which expert physicians disagree.