HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text (PDF) Submit a response Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Merrick, N J Articles by Solomon, D H Search for Related Content PubMed PubMed Citation Articles by Merrick, N J Articles by Solomon, D H

Derivation of clinical indications for carotid endarterectomy by an expert panel.

N J Merrick, A Fink, R E Park, R H Brook, J Kosecoff, M R Chassin and D H Solomon

We used a two-round consensus panel method to derive and rate the appropriateness of comprehensive sets of detailed clinical indications for performing carotid endarterectomy. Before meeting, nine nationally influential physicians rated 675 indications; after review and discussion, they rated 864. The method did not force unanimity; our purposes were not only to encourage agreement but also to uncover areas of disagreement concerning the procedure's appropriate use. The panelists agreed on the level of appropriateness for 54 per cent of the final 864 indications and disagreed on 18 per cent. Ratings were reliably reproduced six to eight months after the completion of the process. The physicians' indications and ratings were consistent with those in the literature, and statistical analysis demonstrated that they followed logical clinical rationale. We conclude that consensus methods that do not force agreement can be used with panels of physicians to produce detailed, reliable, and valid indications. They can also identify medically controversial reasons for using a procedure that can serve as a starting point for a research agenda.

This article has been cited by other articles:

				K. L. Smith, T. A. Soriano, and J. Boal Brief Communication: National Quality-of-Care Standards in Home-Based Primary Care Ann Intern Med, February 6, 2007; 146(3): 188 - 192. [Abstract] [Full Text] [PDF]

				E. A. Halm, S. Tuhrim, J. J. Wang, M. Rojas, E. L. Hannan, and M. R. Chassin Has evidence changed practice?: Appropriateness of carotid endarterectomy after the clinical trials Neurology, January 16, 2007; 68(3): 187 - 194. [Abstract] [Full Text] [PDF]

				M. L. McGory, P. G. Shekelle, and C. Y. Ko Development of Quality Indicators for Patients Undergoing Colorectal Cancer Surgery. J Natl Cancer Inst, November 15, 2006; 98(22): 1623 - 1633. [Abstract] [Full Text] [PDF]

				P. Shekelle The Appropriateness Method Med Decis Making, March 1, 2004; 24(2): 228 - 231. [PDF]

				E. A. Halm, M. R. Chassin, S. Tuhrim, L. H. Hollier, A. J. Popp, E. Ascher, H. Dardik, G. Faust, and T. S. Riles Revisiting the Appropriateness of Carotid Endarterectomy Stroke, June 1, 2003; 34(6): 1464 - 1471. [Abstract] [Full Text] [PDF]

				A. NICOLLIER-FAHRNI, J.-P. VADER, F. FROEHLICH, J.-J. GONVERS, and B. BURNAND Development of appropriateness criteria for colonoscopy: comparison between a standardized expert panel and an evidence-based medicine approach Int. J. Qual. Health Care, February 1, 2003; 15(1): 15 - 22. [Abstract] [Full Text] [PDF]

				E. Z. Oddone, R. D. Horner, D. C.C. Johnston, K. Stechuchak, L. McIntyre, A. Ward, L. G. Alley, J. Whittle, L. Kroupa, and J. Taylor Carotid Endarterectomy and Race: Do Clinical Indications and Patient Preferences Account for Differences? Stroke, December 1, 2002; 33(12): 2936 - 2943. [Abstract] [Full Text] [PDF]

				J M Quintana, J Cabriada, I Lopez de Tejada, M Varona, V Oribe, B Barrios, I Arostegui, and A Bilbao Development of explicit criteria for cholecystectomy Qual. Saf. Health Care, January 12, 2002; 11(4): 320 - 326. [Abstract] [Full Text] [PDF]

				S M Campbell, J Braspenning, A Hutchinson, and M Marshall Research methods used in developing and applying quality indicators in primary care Qual. Saf. Health Care, January 12, 2002; 11(4): 358 - 364. [Abstract] [Full Text] [PDF]

				E. Z. Oddone, R. D. Horner, R. Sloane, L. McIntyre, A. Ward, J. Whittle, L. J. Passman, L. Kroupa, R. Heaney, S. Diem, et al. Race, Presenting Signs and Symptoms, Use of Carotid Artery Imaging, and Appropriateness of Carotid Endarterectomy Stroke, July 1, 1999; 30(7): 1350 - 1356. [Abstract] [Full Text] [PDF]

				W. H. Yeation, J. C. Langenbrunner, J. M. Smyth, and P. M. Wortman Exploratory Research Synthesis: Methodological Considerations for Addressing Limitations in Data Quality Eval Health Prof, September 1, 1995; 18(3): 283 - 303. [Abstract] [PDF]

				E. Z. Oddone, G. Samsa, and D. B. Matchar Global Judgments versus Decision-model-facilitated Judgments: Are Experts Internally Consistent? Med Decis Making, February 1, 1994; 14(1): 19 - 26. [Abstract] [PDF]

				J. A. Linsk American Medical Culture and the Health Care Crisis American Journal of Medical Quality, December 1, 1993; 8(4): 174 - 180. [Abstract] [PDF]