Variations by Specialty in Physician Ratings of the Appropriateness and Necessity of Indications for Procedures

Published In: Medical Care, v. 34, no. 6, June 1996, p. 512-523

Posted on RAND.org on January 01, 1996

by James P. Kahan, Rolla Edward Park, Lucian L. Leape, Steven J. Bernstein, Lee H. Hilborne, Lori Parker, Caren Kamberg, David J. Ballard, Robert H. Brook

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The authors compare the appropriateness ratings and mutual influence of panelists from different specialties who rated a comprehensive set of indications for six surgical procedures. Panelists individually rated the appropriateness of indications at home and then discussed and re-rated the indications during a 2-day meeting. Subsequently, they rated the necessity of those indications scored by the group as appropriate. There were 45 panelists, including specialists (either performers of the procedure or members of a related specialty) and primary care providers, all drawn from nominations by their respective specialty societies. Performers of the procedure had the highest mean ratings, followed by physicians in related specialties, trailed by primary care providers. One fifth of all actual procedures were for indications rated appropriate by performers and less than appropriate by primary care providers. At the panel meetings, primary care providers and related specialists showed no greater tendency to be influenced by other panelists than did performers. Multispecialty panels provide more divergent viewpoints than do panels composed entirely of performers, so fewer actual procedures are deemed performed for appropriate or necessary indications.

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