Shekelle
PG, Kahan JP, Bernstein SJ, Leape LL, Kamberg CJ, Park RE.
The reproducibility of a method to identify the overuse and underuse
of medical procedures.
N Engl J Med 1998;338(26):1888-95.
(Comment in: N Engl J Med. 1998;338(26):1918-20. N Engl J Med. 1998;339(20):1479-80.
N Engl J Med. 1998;339(20):1479; discussion 1480-1.)
The authors performed a parallel, three-way reproducibility of the RAND-University
of California at Los Angeles appropriateness method as applied to two
medical procedures, coronary revascularization and hysterectomy.
“Application of individual panels’ criteria to real populations
of patients resulted in a 100 percent variation in the proportion of cases
classified as inappropriate and a 20 percent variation in the proportion
of cases classified as necessary.”
The discussion notes the variability of physicians’ interpretations
of the importance of patients’ symptoms.
