Abstract
OBJECTIVE: To assess the feasibility of the appropriateness method in the Agency for Health Care Policy and Research (AHCPR) Clinical Practice Guideline Development process, and to compare the results of the appropriateness method with those obtained using evidence tables and an informal consensus method. SETTING: AHCPR Low Back Problems Clinical Practice Guideline. DESIGN: Two different group process methods with the same panel of experts were used in observational comparison of results of and satisfaction with guideline development. DATA COLLECTION: Practice guideline statements were created for topics using the conventional AHCPR method; then six months later new guideline statements for four topics were created using the appropriateness method. Panelist satisfaction with each process and resulting set of guideline statements was assessed. PRINCIPAL FINDINGS: Results of the appropriateness method for TENS, discography, and traction showed no disagreement among panel members and no appropriate indications for their use in the patient scenarios considered. These results are qualitatively similar to the guideline statements produced using evidence tables and informal consensus. Clinical practice guideline statements about electro-diagnostics created from appropriateness ratings were much more clinically specific than those created using evidence tables and informal consensus. Neither informal consensus building nor the appropriateness method was clearly preferred by a majority of panelists. CONCLUSIONS: It is feasible to use the appropriateness method in the AHCPR Clinical Practice Guideline Development process, and in some instances it produces more clinically specific guideline statements than does informal consensus.
Full text
PDF
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Brook R. H., Chassin M. R., Fink A., Solomon D. H., Kosecoff J., Park R. E. A method for the detailed assessment of the appropriateness of medical technologies. Int J Technol Assess Health Care. 1986;2(1):53–63. doi: 10.1017/s0266462300002774. [DOI] [PubMed] [Google Scholar]
- Kosecoff J., Kanouse D. E., Rogers W. H., McCloskey L., Winslow C. M., Brook R. H. Effects of the National Institutes of Health Consensus Development Program on physician practice. JAMA. 1987 Nov 20;258(19):2708–2713. [PubMed] [Google Scholar]
- McDonald C. J., Overhage J. M. Guidelines you can follow and can trust. An ideal and an example. JAMA. 1994 Mar 16;271(11):872–873. [PubMed] [Google Scholar]
- Moses L. E., Emerson J. D., Hosseini H. Analyzing data from ordered categories. N Engl J Med. 1984 Aug 16;311(7):442–448. doi: 10.1056/NEJM198408163110705. [DOI] [PubMed] [Google Scholar]