This Article Full Text (PDF) References Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Oddone, E. Z. Articles by Matchar, D. B. Search for Related Content PubMed PubMed Citation Articles by Oddone, E. Z. Articles by Matchar, D. B. Social Bookmarking                   What's this?

Global Judgments versus Decision-model-facilitated Judgments

Are Experts Internally Consistent?

Gregory Samsa, PhD

David B. Matchar, MD

A widely used method for evaluating the appropriateness of medical procedures and practices is the "modified Delphi" approach using expert panelists' global ratings. However, several difficulties in the assignment of global ratings have led to a search for alternative methods, including the use of decision models. To examine the potential impact of using decision models with an expert panel, the authors compared a panel's global ratings for the appro priateness of carotid endarterectomy with the results of a decision-analytic model in which expert panelists estimated probabilities and utilities that were used as inputs for the model. For 17 different patient scenarios, the nine expert panelists showed variability in "calibration" between the two methods, with their expected utilities calculated from the model generally being higher than their global ratings. However, the correlation between the two methods was excellent. When the panel's median global utility was compared with the panel's median expected utility calculated from the model, the Spearman correlation coefficient was 0.88. This study demonstrated that an expert panel's appropriateness ratings and their expected utilities were highly correlated. In addition, the panelists appeared to be internally consistent in that their judgments about individual probabilities and utilities were correlated with their global judgments. These results should encourage additional efforts to incorporate decision models into the process of clinical guideline development. The authors believe that decision models can help improve a panel's capacity to understand and reconcile discordance, and increase their satisfaction that the process reflects the best possible judgments. Key words: practice guidelines; decision analysis; carotid endarterectomy; stroke. (Med Decis Making 1994;14:19-26)

Medical Decision Making, Vol. 14, No. 1, 19-26 (1994)
DOI: 10.1177/0272989X9401400103


CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

				F. Kee, T. Owen, and R. Leathem Decision Making in a Multidisciplinary Cancer Team: Does Team Discussion Result in Better Quality Decisions? Med Decis Making, November 1, 2004; 24(6): 602 - 613. [Abstract] [PDF]

				P. Shekelle The Appropriateness Method Med Decis Making, March 1, 2004; 24(2): 228 - 231. [PDF]

				E. Z. Oddone, R. D. Horner, D. C.C. Johnston, K. Stechuchak, L. McIntyre, A. Ward, L. G. Alley, J. Whittle, L. Kroupa, and J. Taylor Carotid Endarterectomy and Race: Do Clinical Indications and Patient Preferences Account for Differences? Stroke, December 1, 2002; 33(12): 2936 - 2943. [Abstract] [Full Text] [PDF]

				G. D. Sanders, R. F. Nease JR, and D. K. Owens Design and Pilot Evaluation of a System to Develop Computer-based Site-specific Practice Guidelines from Decision Models Med Decis Making, April 1, 2000; 20(2): 145 - 159. [Abstract] [PDF]

				N. Neil, S. D. Sullivan, and D. S. Lessler The Economics of Treatment for Infants with Respiratory Distress Syndrome Med Decis Making, January 1, 1998; 18(1): 44 - 51. [Abstract] [PDF]