Management of thyroid nodules detected at sonography: Society of Radiologists in Ultrasound Consensus Conference Statement.
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Biopsy, Fine-Needle↗
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Results for “Consensus Statements as Topic”
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Rationale for an international conference series on dietary assessment methods.
The rationale for establishing an international conference series on dietary assessment methods is based on the needs expressed by numerous national and international organizations for better methods of collecting and analyzing dietary data. Dietary assessment is essential for investigating diet-health relationships, formulating policies to reduce health risks, predicting the adequacy of the food supply, and monitoring trends in food use, exposure to contaminants, and compliance with dietary guidelines. The conference rationale is discussed with respect to 1) the need for improved methods to enhance our understanding of diet-health relationships, 2) the need for better methods to facilitate development and monitoring of nutrition-related health objectives, and 3) the importance of international participation. Improved methods for assessing food intakes will enhance our understanding of the role of diet in the etiology and prevention of disease and will facilitate the development of nutrition policy and programs leading to improved health worldwide.
Consensus Statements as Topic↗
Practitioner versus medication-expert opinion on psychiatric pharmacotherapy of mentally retarded patients with mental disorders.
The agreement of practicing psychiatrists with medication experts regarding how psychotropic drugs should be used to treat behavioral and psychiatric problems in patients with mental retardation was studied. The medication survey used in developing guidelines on the treatment of behavioral and psychiatric problems in mental retardation was sent to 85 psychiatrists who had been identified as caring for the mentally retarded in the Texas public mental health system. The comparison of these practitioners with the medication experts included first-line and second-line treatment choices. Survey analysis was based on using 95% confidence intervals (CIs) to determine the type of rating. If the 95% CIs for the practitioners' responses overlapped the 95% CIs for experts, the two groups were judged to be in agreement. Thirty-seven practitioners (43.5%) completed and returned the survey. Few differences between the practitioners and the medication experts were found with respect to treatments for specific mental illness diagnoses. However, the practitioners rated venlafaxine and mirtazapine higher than the medication experts. Lithium augmentation of therapy with selective serotonin-reuptake inhibitors for nonpsychotic depression was rated first-line by the practitioners and second-line by the medication experts. Practicing psychiatrists and medication experts generally agreed about the use of psychotropic drugs for mental illness in patients with mental retardation.
Clinical Competence↗
A response to the ACP-ASIM position paper on pharmacist scope of practice.
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Humans↗
A shared effort toward better quality of care. The Consensus Conference on Breast Cancer Follow-up. Consensus Conference Organizing Committee.
BACKGROUND: Even though several radiological and laboratory tests are currently used in clinical practice for breast cancer surveillance, the benefits of early detection of distant metastases have never been established. Two recently published randomized clinical trials assessing the effectiveness of an intensive follow-up strategy (with periodic clinical examination, mammography, bone scan, liver echography, chest-X-ray and laboratory tests) over a minimalist one (including only periodic clinical examination and mammography) failed to show a significant advantage for the more intensive policy. Intensive follow-up, however, is quite common in clinical practice. AIM OF THE CONSENSUS CONFERENCE: To contribute to the definition of the state of the art in this field and develop recommendations for follow-up in clinical practice. CONDUCT OF THE CONSENSUS CONFERENCE: A Jury, including representatives from all the relevant stakeholders, (professional societies, patients and consumer associations, epidemiologists, health economists and administrators) was convened to critically appraise and interpret available scientific evidence and the information provided by three specific working groups which had the task of examining the clinical, economic and psyco-social aspects of breast cancer follow-up, respectively. CONCLUSIONS: This conference was planned to make explicit and properly represent the viewpoints of all the stakeholders. Furthermore, special efforts were devoted to the development of final recommendations in sufficient detail so as to provide a significant aid for decision-making in clinical practice. It is argued that the Consensus Conference model, designed to elicit and represent the interpretation of scientific evidence by all the stakeholders, would be useful for the development of clinical policies more in line with societal values.
Breast Neoplasms↗
The CITRA research-practice consensus-workshop model: exploring a new method of research translation in aging.
PURPOSE: On the basis of the experience of an extensive community-based research partnership in New York City, we developed an innovative process for bridging the gap between aging-related research and practice, using a consensus-workshop model. DESIGN AND METHODS: We adapted the traditional scientific consensus-workshop model to include translation of the research into nontechnical language and the involvement of practitioners in the process. We then applied the model to the specific issue of falls prevention among community-dwelling older adults. RESULTS: The dialogue and interaction among researchers and practitioners provided new insights beyond a traditional research review. Practitioners offered astute guidance for future research based on their day-to-day field experience. IMPLICATIONS: The recommendations that emerged from the workshop demonstrated the value of close interaction between the aging-related research and practice communities. The consensus-conference model has significant potential to establish a bridge between the worlds of research and practice in a variety of settings.
Accidental Falls↗
How representative are members of expert panels?
A study was undertaken to test the hypothesis that consultants who are willing to participate in expert panels are similar, in terms of routinely available characteristics, to those who are not participating. All consultants in acute specialties in North-east Thames Region were asked to participate in a series of expert panels. Routinely available data was used to compare those who agreed to participate with those who declined or did not reply. Consultants who are willing to participate in expert panels are similar to those who are not in terms of years since qualification, specialty, sex, country of graduation, and possession of higher degrees. Consultants working in district general hospitals seem to be more likely to be willing to participate than those employed in teaching hospitals (37% versus 26%, p less than 0.02), although this difference may be accounted for by errors in the list of teaching hospital consultants.
Attitude of Health Personnel↗
Indications for cholecystectomy: the results of a consensus panel approach.
A consensus panel approach was used in Israel to develop a list of clinical indications for which there was agreement that cholecystectomy should be performed. Nine physicians from different disciplines were asked to score a list of 266 clinical indications for cholecystectomy. Each indication was scored on a scale of 1 (inappropriate, i.e. health risks exceed health benefits) to 9 (appropriate, i.e. benefits exceed risks). Each indication also included one of four comorbidity levels (none to high). Agreement and disagreement were defined and panelists met to discuss, modify and rescore the list. The composition of the panel and definitions of agreement had a considerable impact on the preparation of a list of agreed, appropriate indications for cholecystectomy. Gastroenterologists in the panel were less likely to recommend surgery than either surgeons or general internists both before and after the panel discussion. Following the discussion the level of agreement (defined as after discarding the highest and lowest score all of the remaining seven panelists were in a 3-point range) increased from 39% to 46% (p < 0.08) and disagreement decreased from 27% to 18% (p < 0.01). Fifty-nine of the 266 indications were considered appropriate with agreement.
Attitude of Health Personnel↗
The OECD Health Care Quality Indicators Project: history and background.
OBJECTIVE: To describe the background, history, and approach of the OECD Health Care Quality Indicators (HCQI) Project, an initiative to implement quality measures for international benchmarking of medical care at the health system level. METHOD: The participating countries and international organizations selected five priority areas (cardiac care, diabetes, mental health, patient safety, and primary care/prevention) and developed a conceptual framework to guide the project. International expert panels were formed to identify clinically important, scientifically sound, and feasible measures based on a structured consensus process. RESULTS: The consensus process was successfully completed in all five priority areas leading to a recommendation of 86 indicators. Nine indicators were selected for diabetes, 12 for mental health, 17 for cardiac care, 21 for patient safety, and 27 for primary care and prevention. CONCLUSIONS: The initial experience of the HCQI Project demonstrates that international consensus can be achieved in how to measure the quality of care in priority areas, suggesting substantial demand for and interest in comparative information at the health system level. However, much additional work remains necessary before the project can supply policymakers and researchers with ongoing, comprehensive, and reliable data on the quality of care in industrialized countries.
Benchmarking↗
OECD Health Care Quality Indicator Project. The expert panel on primary care prevention and health promotion.
PURPOSE: This article describes a project undertaken as part of the Organization for Economic Co-operation and Development (OECD)'s Healthcare Quality Indicator (HCQI) Project, which aimed to develop a set of quality indicators representing the domains of primary care, prevention and health promotion, and which could be used to assess the performance of primary care systems. METHODS: Existing quality indicators from around the world were mapped to an organizing framework which related primary care, prevention, and health promotion. The indicators were judged against the US Institute of Medicine's assessment criteria of importance and scientific soundness, and only those which met these criteria and were likely to be feasible were included. An initial large set of indicators was reduced by the primary care expert panel using a modified Delphi process. RESULTS: A set of 27 indicators was produced. Six of them were related to health promotion, covering health-related behaviours that are typically targeted by health education and outreach campaigns, 13 to preventive care with a focus on prenatal care and immunizations and eight to primary clinical care mainly addressing activities related to risk reduction. The indicators selected placed a strong emphasis on the public health aspects of primary care. CONCLUSIONS: This project represents an important but preliminary step towards a set of measures to evaluate and compare primary care quality. Further work is required to assess the operational feasibility of the indicators and the validity of any benchmarking data drawn from international comparisons. A conceptual framework needs to be developed that comprehensively captures the complex construct of primary care as a basis for the selection of additional indicators.
Benchmarking↗
Selecting indicators for the quality of diabetes care at the health systems level in OECD countries.
PURPOSE: In the context of the Organization for Economic Cooperation and Development (OECD) Quality Indicators Project, a set of quality indicators for diabetes care was developed, to be used for benchmarking the performance of health care systems. BACKGROUND: Diabetes complications markedly reduce quality and length of life and are also responsible for enormous health care costs. A large body of evidence has shown that several effective treatments and practices may substantially reduce this burden. However, a marked variability has been documented in preventive and therapeutic approaches, thus suggesting that the level of diabetes care currently delivered may not produce the possible health-related gains. METHODS: Existing quality indicators have been reviewed, with particular attention to the work done by the National Diabetes Quality Improvement Alliance (NDQIA) in the US. All the measures identified were evaluated for their importance, scientific soundness, and feasibility. In addition, the panel members selected new distal outcome measures. These measures are currently not used in provider comparisons, but they could reveal valuable insight into the differential performance of health systems. RESULTS: /b>. Four process and two proximal outcome measures were selected among those endorsed by the NDQIA. In addition, three new long-term outcome measures have been proposed to gain insight into whether and to what degree differences in the processes and intermediate outcomes that are captured by the established measures translate into better outcomes for patients. CONCLUSIONS: The measures selected can contribute to policymakers' and researchers' understanding of differences in the quality of diabetes care between health systems. Further work is required to assess the availability of reliable and comparable data across OECD countries.
Benchmarking↗
Quality indicators for international benchmarking of mental health care.
OBJECTIVE: To identify quality measures for international benchmarking of mental health care that assess important processes and outcomes of care, are scientifically sound, and are feasible to construct from preexisting data. DESIGN: An international expert panel employed a consensus development process to select important, sound, and feasible measures based on a framework that balances these priorities with the additional goal of assessing the breadth of mental health care across key dimensions. PARTICIPANTS: Six countries and one international organization nominated seven panelists consisting of mental health administrators, clinicians, and services researchers with expertise in quality of care, epidemiology, public health, and public policy. Measures. Measures with a final median score of at least 7.0 for both importance and soundness, and data availability rated as 'possible' or better in at least half of participating countries, were included in the final set. Measures with median scores </=3.0 or data availability rated as 'unlikely' were excluded. Measures with intermediate scores were subject to further discussion by the panel, leading to their adoption or rejection on a case-by-case basis. RESULTS: From an initial set of 134 candidate measures, the panel identified 12 measures that achieved moderate to high scores on desired attributes. CONCLUSIONS: Although limited, the proposed measure set provides a starting point for international benchmarking of mental health care. It addresses known quality problems and achieves some breadth across diverse dimensions of mental health care.
Benchmarking↗
Beyond the initial indicators: lessons from the OECD Health Care Quality Indicators Project and the US National Healthcare Quality Report.
UNLABELLED: Interest in comparative quality measurement and evaluation has grown considerably over the past two decades because of factors such as the recognition of widespread variation in clinical practice, the increased availability of evidence about medical effectiveness, and increasing concern about the cost and quality of health care. This article describes and contrasts two current efforts to develop health performance reporting systems: one, an international initiative-the Health Care Quality Indicator (HCQI) Project, sponsored by the Organization for Economic Cooperation and Development (OECD); and the other, a national project-the National Healthcare Quality Report (NHQR), sponsored by the US Agency for Healthcare Quality and Research. There are a number of lessons learned from a comparison of the two efforts that are relevant for the future of each project and for other indicator-based reporting efforts in quality of health care. These lessons are discussed in the article and include: Conceptual frameworks should be established to guide the selection of indicators. Choices should be made early on in the process to focus on a wide range of clinical conditions or to report on a few priority areas. METHODS: should be developed to add and subtract indicators while maintaining a stable set of indicators to track over time. Resources should be allocated to communication strategies and how best to present data results to diverse audiences. Mechanisms should be put in place to maintain project momentum.
Benchmarking↗
Selecting indicators for the quality of cardiac care at the health system level in Organization for Economic Co-operation and Development countries.
BACKGROUND: Cardiovascular (CV) diseases are major causes of morbidity and death in adults in the world. Major differences have been reported in the management strategies and the outcome of CV diseases within and between countries. To better understand and address these differences, there is a need for quantitative information on patient management, outcome, and prognosis. OBJECTIVE: This article describes the development of a set of quality indicators for cardiac care and summarizes work undertaken by the Cardiac Care Panel of the OECD Health Care Quality Indicators Project. METHODS: A list of 61 potential indicators was identified through a literature search, review of national measurement systems, and nomination from countries participating in the project. The Cardiac Care Panel then used a modified Delphi process developed originally by RAND to select indicators. Panel members individually rated each indicator on a scale of 1-9 for scientific soundness and importance. All indicators receiving scores of 7 or more for both importance and soundness were included in the final set. RESULTS: Seventeen cardiac indicators were selected for the final set of indicators from the following areas: acute coronary syndromes, cardiac interventions, secondary prevention, and congestive heart failure. CONCLUSIONS: The final set of 17 indicators selected by the Cardiac Care Panel constitutes a comprehensive set of measures for the most relevant domains of CV care. Nevertheless, gaps remain in the area of primary prevention and in particular in areas with rapidly changing technology and improving treatment options.
Benchmarking↗
Selecting indicators for patient safety at the health system level in OECD countries.
BACKGROUND: Concerns about patient safety have arisen with growing documentation of the extent and nature of harm. Yet there are no robust and meaningful data that can be used internationally to assess the extent of the problem and considerable methodological difficulties. PURPOSE: This article describes a project undertaken as part of the Organization for Economic Cooperation and Development (OECD) Quality Indicator Project, which aimed at developing an initial set of patient safety indicators. METHODS: Patient safety indicators from OECD countries were identified and then rated against three principal criteria: importance to patient safety, scientific soundness, and potential feasibility. Although some countries are developing multi-source monitoring systems, these are not yet mature enough for international exchange. This project reviewed routine data collections as a starting point. RESULTS: Of an initial set of 59 candidate indicators identified, 21 were selected which cover known areas of harm to patients. CONCLUSIONS: This project is an important initial step towards defining a usable set of patient safety indicators that will allow comparisons to be made internationally and will support mutual learning and quality improvement in health care. Measures of harm should be complemented over time with measures of effective improvement factors.
Benchmarking↗
Consensus in panels and committees: conceptual and ethical issues.
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Advisory Committees↗
Committees and consensus: how many heads are better than one?
The first section of this paper asks why the notion of consensus has recently come to the fore in the medical humanities, and suggests that the answer is a function of growing technological and professional complexity. The next two sections examine the concept of consensus analytically, citing some of the recent philosophical literature. The fourth section looks at committee deliberations and their desirable outcomes, and questions the degree to which consensus serves those outcomes. In the fifth and last section it is suggested that if I am to subscribe to a consensual outcome responsibly I must be personally committed to it, and that this requires a form of knowledge I call 'fiduciary', in this case knowledge of the competence and trustworthiness of other participants in deliberation whose expertise may have influenced my agreement.
Advisory Committees↗
Consensus, contracts, and committees.
Following a brief account of the puzzle that ethics committees present for the Western Philosophical tradition, I will examine the possibility that social contract theory can contribute to a philosophical account of these committees. Passing through classical as well as contemporary theories, particularly Rawls' recent constructivist approach, I will argue that social contract theory places severe constraints on the authority that may legitimately be granted to ethics committees. This, I conclude, speaks more about the suitability of the theory to this level of analysis than about the ethics committee phenomenon itself.
Bioethical Issues↗