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Physician ratings of appropriate indications for six medical and surgical procedures
Insights
Physician panels used a modified Delphi process to assess medical procedure appropriateness. Final ratings showed improved agreement compared to initial assessments, with consensus reached on 42-56% of indications.
Area of Science:
- Medical appropriateness evaluation
- Physician consensus building
Background:
- Assessing the appropriateness of medical and surgical procedures is crucial for evidence-based practice.
- Variability in clinical practice necessitates standardized evaluation of procedure indications.
Purpose of the Study:
- To determine physician agreement on the appropriateness of indications for six medical and surgical procedures.
- To evaluate the effectiveness of a modified Delphi process in achieving consensus.
Main Methods:
- Convened three panels of physicians to rate procedure indications.
- Utilized a modified Delphi process involving separate initial ratings, group discussion, and final individual ratings.
- Provided panelists with comparative rating data to facilitate discussion and revision.
Main Results:
- Physician agreement on indications improved from initial to final ratings.
- Excluding one procedure, panelists agreed on 42-56% of indications and disagreed on 11-29%.
- The modified Delphi process facilitated enhanced consensus among physician panelists.
Conclusions:
- The modified Delphi process is effective in achieving physician consensus on procedure appropriateness.
- A significant portion of indications reached agreement, indicating potential for standardized guidelines.
- Further refinement of criteria may improve agreement rates for medical and surgical procedure indications.
Abstract:
We convened three panels of physicians to rate the appropriateness of a large number of indications for performing a total of six medical and surgical procedures. The panels followed a modified Delphi process. Panelists separately assigned initial ratings, then met in Santa Monica, California where they received reports showing their initial ratings and the distribution of the other panelists ratings. They discussed the indications and revised the indications lists, then individually assigned final ratings. There was generally better agreement on the final ratings than on the initial ratings. Based on reasonable criteria for agreement and disagreement, and excluding one outlying procedure, the panelists agreed on ratings for 42 to 56 per cent of the indications, and disagreed on 11 to 29 per cent.