Journal of Clinical Epidemiology
Volume 52, Issue 4 , Pages 309-319, April 1999

Understanding Variability in Physician Ratings of the Appropriateness of Coronary Angiography After Acute Myocardial Infarction

  • Mary Beth Landrum

      Affiliations

    • Department of Health Care Policy, Harvard Medical School, Boston, MA USA
    • Corresponding Author InformationAddress correspondence to: Mary Beth Landrum, Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115
    • ,
  • Barbara J. McNeil

      Affiliations

    • Department of Health Care Policy, Harvard Medical School, Boston, MA USA
    • Department of Radiology, Brigham and Women’s Hospital, Boston, MA USA
    • ,
  • Laurie Silva

      Affiliations

    • Department of Health Care Policy, Harvard Medical School, Boston, MA USA
    • ,
  • Sharon-Lise T. Normand

      Affiliations

    • Department of Health Care Policy, Harvard Medical School, Boston, MA USA
    • Department of Biostatistics, Harvard School of Public Health, Boston, MA USA

Accepted 6 November 1998.

Abstract 

We examined variability in ratings of the appropriateness of coronary angiography for 890 clinical scenarios (indications) after an acute myocardial infarction (AMI) from a nine-member multispecialty panel as a function of panel characteristics and the attributes of the clinical indications. We documented a substantial degree of reliability in the ratings. However, key differences among the experts in terms of both their overall propensity to score high and their beliefs regarding the impact of clinical factors on appropriateness were identified. Age, cardiac complications, post-AMI angina, and noninvasive test results were the clinical factors most strongly related to appropriateness ratings for coronary angiography. Further research on the effectiveness of coronary angiography in older patients and in patients with shock, pulmonary edema, and silent ischemia is needed to improve our knowledge about the appropriateness of this procedure in these patients.

Keywords:  Practice guidelines, angiography, AMI, expert panels, appropriateness ratings, hierarchical models

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PII: S0895-4356(98)00166-8

Journal of Clinical Epidemiology
Volume 52, Issue 4 , Pages 309-319, April 1999

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