Rating the appropriateness of coronary angiography--do practicing physicians agree with an expert panel and with each other?

The New England Journal of Medicine
J Z AyanianB J McNeil

Abstract

Evaluations of the appropriateness of medical care are important to monitor the quality of care and to contain costs and enhance safety by reducing inappropriate care. Experts' views are usually incorporated into evaluations of appropriateness. However, practicing physicians may not concur with these views, and physicians' clinical backgrounds may influence their beliefs. We asked 1058 internists, family practitioners, and cardiologists in California, Florida, New York, Pennsylvania, and Texas to rate the appropriateness of coronary angiography after acute myocardial infarction for 20 common indications. Nine clinical experts also rated these indications using an established consensus method. For 17 of the 20 indications, median ratings of surveyed physicians and the expert panel agreed within 1 unit on a 9-unit scale. Patients' older age had a negative effect on ratings by the expert panel but not on ratings by surveyed physicians. In multivariable analyses of surveyed physicians, cardiologists rated angiography as significantly more appropriate than did primary care physicians for complicated indications, and for uncomplicated indications cardiologists who performed invasive procedures gave higher appropriateness ratings for ...Continue Reading

References

Nov 13, 1987·JAMA : the Journal of the American Medical Association·M R ChassinR H Brook
Jul 1, 1986·American Journal of Public Health·R E ParkD H Solomon
Nov 15, 1995·Journal of the American College of Cardiology·S J BorowskyR H Brook
Aug 31, 1995·The New England Journal of Medicine·E GuadagnoliP D Cleary
Jul 1, 1995·Journal of Clinical Epidemiology·R N BattistaP Vineis
Jun 1, 1994·Annals of Internal Medicine·S R TunisE P Steinberg
Jul 21, 1993·JAMA : the Journal of the American Medical Association·J Blustein
Oct 21, 1993·The New England Journal of Medicine·C E Phelps
Feb 1, 1996·Journal of the American College of Cardiology·T T Di SalvoP T O'Gara
Dec 19, 1996·The New England Journal of Medicine·J G JollisD B Mark
Apr 1, 1997·Annals of Internal Medicine·D W BatesL L Leape
Apr 1, 1997·Annals of Internal Medicine·E D PetersonR M Califf
Nov 22, 1997·Journal of Clinical Epidemiology·D A AschN A Christakis

❮ Previous
Next ❯

Citations

Sep 10, 2002·The Journal of Behavioral Health Services & Research·Nancy Wolff, Mark Schlesinger
May 3, 2005·Gynecologic Oncology·Anna R GagliardiAdalsteinn D Brown
Jun 27, 2002·Journal of the American College of Cardiology·D A AlterJ V Tu
Aug 15, 2000·Journal of Clinical Epidemiology·S C DalyS J Jacobsen
Feb 12, 2002·European Journal of Internal Medicine·John Kellett
May 8, 2001·International Journal of Medical Informatics·B Sadan
Jul 8, 2008·International Journal of Technology Assessment in Health Care·Claudia SanmartinTom Noseworthy
Aug 8, 2002·Journal of the American Geriatrics Society·Debra Saliba, John F Schnelle
Jun 25, 1998·The New England Journal of Medicine·C D Naylor
Dec 5, 1998·The New England Journal of Medicine·S Wassertheil-SmollerR Steingart
Oct 12, 2010·Telemedicine Journal and E-health : the Official Journal of the American Telemedicine Association·Cynthia LeRougePamela Forducey
Feb 8, 2013·Japanese Journal of Clinical Oncology·Takahiro HigashiTomotaka Sobue
Dec 19, 2002·Journal of the National Cancer Institute·Steven Joffe, Jane C Weeks
Jan 14, 2011·Plastic and Reconstructive Surgery·Robert A Warriner, Marissa J Carter
Feb 7, 2001·BMJ : British Medical Journal·K VellaN Black
Dec 19, 2002·Quality & Safety in Health Care·H TiemeierH Rigter
Dec 7, 2002·Quality & Safety in Health Care·S M CampbellM Marshall
Nov 13, 2008·American Journal of Medical Quality : the Official Journal of the American College of Medical Quality·Ethan A HalmMark R Chassin
Jul 9, 2004·BMC Health Services Research·James KennedyWilliam A Ghali
Dec 1, 2006·Health Research Policy and Systems·Atle FretheimAndrew D Oxman
Aug 23, 2012·PloS One·Stephanie PolusA Metin Gülmezoglu
Oct 17, 2013·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·Tristan D YanUNKNOWN International VATS Lobectomy Consensus Group
Jun 27, 2008·International Journal of Health Care Quality Assurance·Anna GagliardiVivek Goel
Jul 10, 2001·American Journal of Public Health·E F PhilbinW D Weaver
Nov 26, 2009·The International Journal of Cardiovascular Imaging·Philipp Wagdi, Hatem Alkadhi
May 15, 2012·International Journal of Medical Informatics·Cynthia LeRougeRosann Webb Collins
Jul 11, 2002·Mayo Clinic Proceedings·Véronique L RogerBernard J Gersh
Apr 30, 2008·Journal of the American College of Radiology : JACR·Christopher Lee Sistrom, UNKNOWN American College of Radiology

❮ Previous
Next ❯

Related Concepts

Trending Feeds

COVID-19

Coronaviruses encompass a large family of viruses that cause the common cold as well as more serious diseases, such as the ongoing outbreak of coronavirus disease 2019 (COVID-19; formally known as 2019-nCoV). Coronaviruses can spread from animals to humans; symptoms include fever, cough, shortness of breath, and breathing difficulties; in more severe cases, infection can lead to death. This feed covers recent research on COVID-19.

Blastomycosis

Blastomycosis fungal infections spread through inhaling Blastomyces dermatitidis spores. Discover the latest research on blastomycosis fungal infections here.

Nuclear Pore Complex in ALS/FTD

Alterations in nucleocytoplasmic transport, controlled by the nuclear pore complex, may be involved in the pathomechanism underlying multiple neurodegenerative diseases including Amyotrophic Lateral Sclerosis and Frontotemporal Dementia. Here is the latest research on the nuclear pore complex in ALS and FTD.

Applications of Molecular Barcoding

The concept of molecular barcoding is that each original DNA or RNA molecule is attached to a unique sequence barcode. Sequence reads having different barcodes represent different original molecules, while sequence reads having the same barcode are results of PCR duplication from one original molecule. Discover the latest research on molecular barcoding here.

Chronic Fatigue Syndrome

Chronic fatigue syndrome is a disease characterized by unexplained disabling fatigue; the pathology of which is incompletely understood. Discover the latest research on chronic fatigue syndrome here.

Evolution of Pluripotency

Pluripotency refers to the ability of a cell to develop into three primary germ cell layers of the embryo. This feed focuses on the mechanisms that underlie the evolution of pluripotency. Here is the latest research.

Position Effect Variegation

Position Effect Variagation occurs when a gene is inactivated due to its positioning near heterochromatic regions within a chromosome. Discover the latest research on Position Effect Variagation here.

STING Receptor Agonists

Stimulator of IFN genes (STING) are a group of transmembrane proteins that are involved in the induction of type I interferon that is important in the innate immune response. The stimulation of STING has been an active area of research in the treatment of cancer and infectious diseases. Here is the latest research on STING receptor agonists.

Microbicide

Microbicides are products that can be applied to vaginal or rectal mucosal surfaces with the goal of preventing, or at least significantly reducing, the transmission of sexually transmitted infections. Here is the latest research on microbicides.