Reliability of Panel-Based Guidelines for Colonoscopy

An International Comparison

Published in: Gastrointestinal Endoscopy, v. 47, no. 2, Feb. 1998, p. 162-166

Posted on on January 01, 1998

by Bernard Burnand, John Paul Vader, Florian Froehlich, Karine Dupriez, Tania Larequi-Lauber, Isabelle Pache, Robert W. Dubois, Robert H. Brook, Jean-Jacques Gonvers

Read More

Access further information on this document at

This article was published outside of RAND. The full text of the article can be found at the link above.

This study examined the reliability of explicit guidelines developed using the RAND-UCLA appropriateness method. The appropriateness of over 400 indications for colonoscopy was rated by two multispecialty expert panels (United States and Switzerland). A nine-point scale was used, which was consolidated into three categories of appropriateness: appropriate, uncertain, inappropriate. The distribution of appropriateness ratings between the two panels and the intrapanel and interpanel agreement for categories of appropriateness were calculated for all possible indications. Similar statistics were calculated for a series of 577 primary care patients referred for colonoscopy in Switzerland. Over 805 of all indications (348) could be directly compared. The proportions of indications classified as appropriate, uncertain, or inappropriate were 28.45, 24.7%, 46.6% and 33.0%, 23.0%, 44.0% for the U.S. and Swiss panels, respectively. Interpanel agreement was excellent for all the possible indications (kappa value: 0.75) and lower for actual cases (kappa value: 0.51) because of lower agreement for the most frequently encountered indications. Good agreement between the two sets of criteria was found, pointing to the reliability of the method. Partial disagreement occurred essentially for a few, albeit frequently encountered, indications for use of colonoscopy in cases of uncomplicated lower abdominal pain or constipation.

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

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.