Coronary Angiography and Revascularization

Presents the results of a Canadian panel that assessed the appropriateness and necessity of coronary angiography and coronary revascularization using the RAND appropriateness method. The RAND method is a formal two-step process whereby panelists in their home locations pre-rate indications (specific clinical scenarios) for medical procedures (Round 1) and then convene to discuss and re-rate the same indications (Round 2). Results indicated that agreement among the panel members for rating the appropriateness of coronary angiography increased from 38 percent in Round 1 to 64 percent in Round 2. There was a similar level of increased agreement for coronary revascularization, from 43 percent to 54 percent. Although the authors conclude that the two-step panel process permitted convergence of panelists' ratings, they also state that continuing disagreement on ratings underscored the need to avoid a forced consensus. Instead, divergent opinions should be taken as indicative of uncertainty about the appropriateness of intervention.