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.

This report is part of the RAND Corporation External publication series. Many RAND studies are published in peer-reviewed scholarly journals, as chapters in commercial books, or as documents published by other organizations.

Our mission to help improve policy and decisionmaking through research and analysis is enabled through our core values of quality and objectivity and our unwavering commitment to the highest level of integrity and ethical behavior. To help ensure our research and analysis are rigorous, objective, and nonpartisan, we subject our research publications to a robust and exacting quality-assurance process; avoid both the appearance and reality of financial and other conflicts of interest through staff training, project screening, and a policy of mandatory disclosure; and pursue transparency in our research engagements through our commitment to the open publication of our research findings and recommendations, disclosure of the source of funding of published research, and policies to ensure intellectual independence. For more information, visit www.rand.org/about/principles.

The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.