Coronary Angiography and Revascularization

Defining Procedural Indications Through Formal Group Processes

Published in: Canadian Journal of Cardiology, v. 10, No. 1, Jan-Feb 1994, p. 41-48

Posted on RAND.org on December 31, 1993

by C. Naylor, Elizabeth A. McGlynn, Lucian L. Leape, S. Pinfold, Steven J. Bernstein, Lee H. Hilborne, Rolla Edward Park, James P. Kahan, Robert H. Brook

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.

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