PubMed · 3295142
The source did not provide an abstract. Follow the original record for more information.
Explore connections, maps & timelines
H S Chaney. 1987. Needs assessment: a Delphi approach.. https://pubmed.ncbi.nlm.nih.gov/3295142/
Cite the original work for its findings. Save a collection to share your selection of sources.
KEEP EXPLORING
Molecular tests without well-defined test performance characteristics are increasingly available for diagnosis of infectious diseases. These tests present a diagnostic stewardship challenge for institutions. We share the results of a local modified Delphi consensus undertaken to define appropriate scenarios for use of plasma metagenomic next-generation sequencing.
OBJECTIVE: To identify the strong and weak points of Palmer's Quality Method as it applies to Primary Care (PC), and determine the areas of quality assurance to which it is most suited. DESIGN: Delphi Study. SETTING: Primary Care-related professionals, homogeneously distributed throughout the different autonomous communities. PARTICIPANTS: 52 assurance experts selected on the basis of their publications, and from lists provided by well known, prestigious experts. METHOD: Each expert was first contacted by phone to request participation in the study. The first questionnaire that was sent asked the participants to respond to the following questions: "Which are, in your judgement, the positive aspects (strong points) and negative aspects (weak points) of Palmer's Quality Method with regard to PC?" and "In which quality assurance area do you think its use is most effective?" RESULTS: Respondents to the first questionnaire (35 experts) listed 125 strong points, 111 weak points and 52 areas. After similar responses were grouped together, the resulting totals were 67 strong points, 40 weak points and 11 areas. The second questionnaire was rated by 32 experts. The third questionnaire was then created using the 7 highest-scoring answers, including the average score and scoring variance for each question. Thirty-one experts responded. Ultimately, 8 strong points, 7 weak points and 7 areas of quality assurance were obtained. CONCLUSIONS: Palmer's method continues to be useful in quality assurance work in PC. We believe that this study can serve to facilitate its use and suggest those situations where its use is most effective.
BACKGROUND: To assess the overuse and underuse of medical procedures, various methods have been developed, but their reproducibility has not been evaluated. This study estimates the reproducibility of one commonly used method. METHODS: We performed a parallel, three-way replication of the RAND-University of California at Los Angeles appropriateness method as applied to two medical procedures, coronary revascularization and hysterectomy. Three nine-member multidisciplinary panels of experts were composed for each procedure by stratified random sampling from a list of experts nominated by the relevant specialty societies. Each panel independently rated the same set of clinical scenarios in terms of the appropriateness of the relevant procedure on a risk-benefit scale ranging from 1 to 9. Final ratings were used to classify the procedure in each scenario as necessary or not necessary (to evaluate underuse) and inappropriate or not inappropriate (to evaluate overuse). Reproducibility was measured by overall agreement and by the kappa statistic. The criteria for underuse and overuse derived from these ratings were then applied to real populations of patients who had undergone coronary revascularization or hysterectomy. RESULTS: The rates of agreement among the three coronary-revascularization panels were 95, 94, and 96 percent for inappropriate-use scenarios and 93, 92, and 92 percent for necessary-use scenarios. Agreement among the three hysterectomy panels was 88, 70, and 74 percent for inappropriate-use scenarios. Scenarios involving necessary use of hysterectomy were not assessed. The three-way kappa statistic to detect overuse was 0.52 for coronary revascularization and 0.51 for hysterectomy. The three-way kappa statistic to detect underuse of coronary revascularization was 0.83. Application of individual panels' criteria to real populations of patients resulted in a 100 percent variation in the proportion of cases classified as inappropriate and a 20 percent variation in the proportion of cases classified as necessary. CONCLUSIONS: The appropriateness method is far from perfect. Appropriateness criteria may be useful in comparing levels of appropriate procedures among populations but should not by themselves be used to direct care for individual patients.