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PubMed1989

Reporting consensus.

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Consensus Statements as Topic↗
PubMed1997

Quality assurance in conformal radiotherapy: DYNARAD consensus report on practice guidelines.

BACKGROUND AND PURPOSE: Conformal radiotherapy has only recently been widely implemented. Although not all aspects have yet been adequately proven, it is generally recognized that maintaining a high degree of precision throughout the process is critical to the treatment outcome while the focus for quality assurance and quality improvement will need to concentrate more on human factors, procedures, communication, organization and training. A general consensus document on quality assurance guidelines for institutions that deliver conformal radiotherapy treatments to patients has been elaborated within the framework of the DYNARAD/BIOMED concerted action on conformal radiotherapy. The present paper aims to highlight those issues that were identified as of specific importance to conformal radiotherapy. The work reported here further details this guidance by direct correlation with the issues involved in the special case of conformal radiotherapy. METHODS: The DYNARAD document has been drafted in the form of a desktop guide comprising six sets of guidelines and is based on the ESTRO advisory report on 'Quality Assurance in Radiotherapy'. RESULTS AND CONCLUSIONS: The document has been endorsed by the DYNARAD group of institutions. As such it can form the basis for further discussions and enter into the subsequent phase of expanding its consensus basis.

Consensus Statements as Topic↗
PubMed1997

Effect of panel composition on physician ratings of appropriateness of abdominal aortic aneurysm surgery: elucidating differences between multispecialty panel results and specialty society recommendations.

OBJECTIVE: To investigate how the composition of multispecialty physician panels is associated with both the summary ratings assigned by such panels and the agreement of such panels with the recommendations of specialty societies. DATA SOURCES/STUDY SETTING: We examined the final ratings assigned by a nine-member multispecialty RAND Corporation physician panel regarding indications for abdominal aortic aneurysm surgery and the recommendations of a specialty society representing vascular surgeons who perform the same surgery. STUDY DESIGN: The panel was retrospectively divided into two sub-panels, one composed of the three vascular surgeons on the panel and the other composed of the six remaining physicians. We analyzed the two sub-panels' rating patterns with respect to each other and with respect to concurrent guidelines generated by the Joint Council of the Society of Vascular Surgery and the North American Chapter of the International Society for Cardiovascular Surgery. PRINCIPAL FINDINGS: Of the 782 indications considered by the panel for appropriateness, the vascular surgeons had an average of mean ratings for appropriateness of 5.1, significantly higher than the 4.5 average of the other physicians. Across the 221 indications considered by the panel for necessity, the vascular surgeons had an average of mean necessity ratings of 6.8, significantly higher than the 5.8 average of the other physicians. The vascular surgeons' rankings of agreement with the guidelines of the Joint Council were significantly higher than those of the physician panelists from other specialties. CONCLUSIONS: statements of clinical appropriateness and necessity produced by summarizing ratings assigned to indications by expert panel members may disguise marked underlying disagreements among well-defined groups of practitioners within these panels. In the case of abdominal aortic aneurysm management, these disagreements within the RAND panel explain the marked discrepancy between the RAND multidisciplinary panel ratings and the recommendations issued by vascular surgeon professional societies.

Aortic Aneurysm, Abdominal↗
PubMed1997

Measuring the clinical consistency of panelists' appropriateness ratings: the case of coronary artery bypass surgery.

OBJECTIVE: To assess the clinical consistency of expert panelists' ratings of appropriateness for coronary artery bypass surgery. DESIGN: Quantitative analysis of panelists' ratings. PARTICIPANTS: Nine physicians (three cardiothoracic surgeons, four cardiologists, and two internists) convened by RAND to establish criteria for the appropriateness of coronary artery bypass surgery. MAIN OUTCOMES MEASURES: Percentage of indication-pairs given clinically inconsistent ratings (i.e. higher rating assigned to one member of an indication-pair when rating should have been equal or lower). RESULTS: In the final round of appropriateness ratings, among 1785 pairs of indications differing only on a single clinical factor (e.g., three-vessel vs. two-vessel stenosis), 6.6% were assigned clinically inconsistent ratings by individual panelists, but only 2.7% received inconsistent ratings from the panel as a whole (using the median panel rating as the criterion). Internists on the panel provided fewer inconsistent ratings (4.6%) than either cardiologists (7.8%) or cardiothoracic surgeons (6.3%) (p < 0.001). More inconsistencies were noted when the factor distinguishing otherwise identical indications was symptom severity (inconsistency rate, 13.2%) or intensity of medical therapy (13.2%) than when it was number of stenosed vessels (3.8%) or proximal left anterior descending (PLAD) involvement (1.9%). Contrary to expectations, panelists' inconsistency rates increased between the initial and final rounds of appropriateness ratings (from 3.9 to 6.6%, p < 0.001). Panelists' mean ratings across indications were only weakly correlated with individual inconsistency rates (r = 0.18, p = ns). CONCLUSIONS: The RAND/UCLA method for assessing the appropriateness of coronary revascularization generally produces criteria that are clinically consistent. However, research is needed to understand the sources of panelists' inconsistencies and to reduce inconsistency rates further.

Consensus Statements as Topic↗
PubMed1999

Varese meeting report.

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Consensus Statements as Topic↗