Concordance of Physician Ratings With the Appropriate Use Criteria for Coronary Revascularization

Objectives The objective of this study was to compare the consistency in appropriate use criteria (AUC) ratings among a broad range of practicing cardiologists and the AUC Technical Panel. Background AUC for coronary revascularization have been developed by selected experts. Methods Before AUC publi...

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Bibliographic Details
Published in:Journal of the American College of Cardiology 2011-04, Vol.57 (14), p.1546-1553
Main Authors: Chan, Paul S., MD, MSc, Brindis, Ralph G., MD, MPH, Cohen, David J., MD, MSc, Jones, Philip G., MSc, Gialde, Elizabeth, RN, Bach, Richard G., MD, Curtis, Jeptha, MD, Bethea, Charles F., MD, Shelton, Marc E., MD, Spertus, John A., MD, MPH
Format: Article
Language:English
Subjects:
angioplasty
appropriateness
Biological and medical sciences
Cardiology
Cardiology. Vascular system
Cardiovascular
Confidence intervals
Coronary heart disease
coronary revascularization
Coronary vessels
Female
Heart
Heart surgery
Humans
Internal Medicine
Ischemia
Male
Medical sciences
Mortality
Myocardial Revascularization
Patient Selection
Practice Patterns, Physicians
Ratings & rankings
Studies
Veins & arteries
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Summary:Objectives The objective of this study was to compare the consistency in appropriate use criteria (AUC) ratings among a broad range of practicing cardiologists and the AUC Technical Panel. Background AUC for coronary revascularization have been developed by selected experts. Methods Before AUC publication, 85 cardiologists from 10 U.S. institutions assessed the appropriateness of coronary revascularization for 68 indications that had been evaluated by the AUC Technical Panel. Each indication was classified as appropriate, uncertain, or inappropriate, based on the physician group's median rating. Rates of concordance between the physician group and the AUC Technical Panel (i.e., same appropriateness category assignment) and rates of nonagreement within the physician group (≥25% of panelists' ratings outside the group's appropriateness category assessment) were determined. Results Overall concordance between the 2 groups was 84%. Among indications classified as appropriate by the AUC Technical Panel, concordance between the 2 groups was excellent (94% [34 of 36]); however, nonagreement within the physician group was 44% (16 of 36). Among indications classified as uncertain, there was 73% (16 of 22) concordance between the 2 groups. Among inappropriate indications, concordance was moderate (70% [7 of 10]), but nonagreement occurred frequently (70% [7 of 10]). Moreover, there was substantial variation in appropriateness ratings between individual physicians and the AUC Technical Panel (weighted kappa range: 0.05 to 0.76). Conclusions Although there was good concordance in assessments of appropriateness for coronary revascularization between physicians and the AUC Technical Panel, nonagreement within the physician group was common and there was marked variation in ratings between individual physicians and the AUC Technical Panel.
ISSN:0735-1097
1558-3597
DOI:10.1016/j.jacc.2010.10.050