title: Concordance of physician ratings with the appropriate use criteria for coronary revascularization.
abstract: OBJECTIVE
  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.
authors: Saint Luke's Mid America Heart Institute, Kansas City, Missouri 64111, USA. pchan@cc-pc.com
authors: Paul S
authors: PS
authors: Chan
authors: Ralph G
authors: RG
authors: Brindis
authors: David J
authors: DJ
authors: Cohen
authors: Philip G
authors: PG
authors: Jones
authors: Elizabeth
authors: E
authors: Gialde
authors: Richard G
authors: RG
authors: Bach
authors: Jeptha
authors: J
authors: Curtis
authors: Charles F
authors: CF
authors: Bethea
authors: Marc E
authors: ME
authors: Shelton
authors: John A
authors: JA
authors: Spertus
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D009204:Myocardial Revascularization; D018579:Patient Selection; D010818:Practice Patterns, Physicians'