Physician ratings of appropriate indications for six medical and surgical procedures.

Park, Rolla Edward; Fink, Arlène; Brook, Robert H.; Chassin, Mark R.; Kahn, Katherine L.; Merrick, Nancy J.; Kosecoff, Jacqueline; Solomon, David H.

doi:10.2105/ajph.76.7.766

Cited by 340 publications

(147 citation statements)

References 6 publications

Supporting

Mentioning

144

Contrasting

Order By: Relevance

“…Since 1977, the U.S. National Institutes of Health have convened over 40 consensus panels to resolve issues relating to the safety and efficacy of new medical technologies. Similarly, researchers at the Rand Corporation have found consensus approaches very useful for assessing the appropriateness of diagnostic and therapeutic interventions against heart disease, colon cancer, and stroke (43,87). The CDC used a formal consensus technique to judge the appropriativeness of various treatments of isoniazid-resistant tuberculosis infection (88).…”

Section: Discussionmentioning

confidence: 99%

Environmental pollutants and disease in American children: estimates of morbidity, mortality, and costs for lead poisoning, asthma, cancer, and developmental disabilities.

Landrigan

Schechter

Lipton

et al. 2002

Environ Health Perspect

451

283

View full text Add to dashboard Cite

In this study, we aimed to estimate the contribution of environmental pollutants to the incidence, prevalence, mortality, and costs of pediatric disease in American children. We examined four categories of illness: lead poisoning, asthma, cancer, and neurobehavioral disorders. To estimate the proportion of each attributable to toxins in the environment, we used an environmentally attributable fraction (EAF) model. EAFs for lead poisoning, asthma, and cancer were developed by panels of experts through a Delphi process, whereas that for neurobehavioral disorders was based on data from the National Academy of Sciences. We define environmental pollutants as toxic chemicals of human origin in air, food, water, and communities. To develop estimates of costs, we relied on data from the U.S. Environmental Protection Agency, Centers for Disease Control and Prevention, National Center for Health Statistics, the Bureau of Labor Statistics, the Health Care Financing Agency, and the Practice Management Information Corporation. EAFs were judged to be 100% for lead poisoning, 30% for asthma (range, 10-35%), 5% for cancer (range, 2-10%), and 10% for neurobehavioral disorders (range, 5-20%). Total annual costs are estimated to be $54.9 billion (range $48.8-64.8 billion): $43.4 billion for lead poisoning, $2.0 billion for asthma, $0.3 billion for childhood cancer, and $9.2 billion for neurobehavioral disorders. This sum amounts to 2.8 percent of total U.S. health care costs. This estimate is likely low because it considers only four categories of illness, incorporates conservative assumptions, ignores costs of pain and suffering, and does not include late complications for which etiologic associations are poorly quantified. The costs of pediatric environmental disease are high, in contrast with the limited resources directed to research, tracking, and prevention.

show abstract

Section: Discussionmentioning

confidence: 99%

Environmental pollutants and disease in American children: estimates of morbidity, mortality, and costs for lead poisoning, asthma, cancer, and developmental disabilities.

Landrigan

Schechter

Lipton

et al. 2002

Environ Health Perspect

451

283

View full text Add to dashboard Cite

show abstract

“…Brook and colleagues (Park et al 1986) had nine medical experts rate a large number of possible indications for carotid endarterectomy on a scale of 1 for highly inappropriate to 9 for highly appropriate. We consider results for 848 indications rated by all raters.…”

Section: Expert Ratings On Appropriateness Of Carotid Endarterectomymentioning

confidence: 99%

Statistical Modeling of Expert Ratings on Medical Treatment Appropriateness

Uebersax

1993

Journal of the American Statistical Association

View full text Add to dashboard Cite

This article uses latent structure analysis to model ordered category ratings by multiple experts on the appropriateness of indications for the medical procedure carotid endarterectomy. The statistical method used is a form of located latent class analysis, which combines elements of latent class and latent trait analysis. It assumes that treatment indications fall into distinct latent classes, with each latent class corresponding to a different level of appropriateness. The appropriateness rating of a treatment indication by a rater is assumed determined by the latent class membership of the indication, rating category thresholds of the rater, and random measurement error. The located latent class model has two alternative forms: a normal ogive form, which derives from the assumption of normally distributed measurement error, and a logistic approximation to the normal form. The approach has the following advantages for the analysis of ordered category ratings by multiple experts: ( 1 ) it assesses whether different raters base ratings on the same or different criteria; ( 2 ) it assesses rater bias-the tendency of some raters to make higher or lower ratings than others; ( 3 ) it characterizes rater differences in rating category definitions; ( 4 ) it provides theoretically based methods for combining the ratings of different raters; and ( 5 ) it provides a description of the distribution of the latent trait. The data examined are appropriateness ratings on 848 indications for carotid endarterectomy made by nine medical experts. The located latent class approach provides unique insights concerning the data. It identifies what appears to be a set of clear nonindications for carotid endarterectomy, but a corresponding set of clear indications is not evident. The results indicate that all raters measured a common latent trait of treatment appropriateness, but that some measured the trait better than others. Rater differences in overall bias and rating category definitions are evident. Two methods are used to combine raters' ratings. One uses ratings to calculate a continuous appropriateness score for each indication. The other uses ratings to assign indications to discrete outcome categories, each corresponding to a specific level of appropriateness. The located latent class approach for ordered category measures has possible applications besides the analysis of expert ratings, such as item analysis. Potential extensions of the model are discussed.KEY WORDS: Expert ratings; Health care; Latent class analysis; Latent trait analysis; Observer agreement; Ordered category data. I. INTRODUCTION1986), who had panels of national experts rate the appropriateness of several medical treatments. There is much recent concern about ensuring the approBecause of space limitations, only a brief synopsis of stapriateness of medical treatment. One proposed strategy for tistical methods for the analysis of multiple expert rating establishing treatment standards is to have expert panels re-data with ordered categories is provided. More...

show abstract

“…They are defi ned by the Institute of Medicine as "systematically developed statements to assist practitioner and patient decisions about appropriate health care for specifi c clinical circumstances" [1]. Appropriate care involves assessing the balance between the sum of the benefi ts and the sum of the risks [2].…”

Section: The Relevance Of the Spanish Society For Medical Oncology (Smentioning

confidence: 99%

The relevance of the Spanish society for medical oncology (SEOM)’s clinical oncology guidelines

2010

View full text Add to dashboard Cite

Physician ratings of appropriate indications for six medical and surgical procedures.

Cited by 340 publications

References 6 publications

Environmental pollutants and disease in American children: estimates of morbidity, mortality, and costs for lead poisoning, asthma, cancer, and developmental disabilities.

Environmental pollutants and disease in American children: estimates of morbidity, mortality, and costs for lead poisoning, asthma, cancer, and developmental disabilities.

Statistical Modeling of Expert Ratings on Medical Treatment Appropriateness

The relevance of the Spanish society for medical oncology (SEOM)’s clinical oncology guidelines

Contact Info

Product

Resources

About