This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Social Bookmarking   What's this?

R. P. (Jack) Davidson, MD, MBA
St Louis, Mo

JAMA. 1993;270(11):1317.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

To the Editor.

—Several aspects of the study by Bernstein et al¹ deserve further discussion.

In the absence of longitudinal, outcomes-based studies defining which patients benefit from a given intervention, efforts to determine appropriateness of care must rely on the use of expert opinion. Attempts to model the decision-making process of experts and incorporate expert opinion into a series of portable algorithms represent a major advancement in the development of appropriateness criteria. However, it is important to bear in mind the limitations inherent in this approach.

Depending on the quality and quantity of scientific information available to them, experts frequently disagree, and even when they agree, experts can be wrong. Despite obvious weaknesses, the current criterion standard for appropriateness determinations is individual case review by experts in the same field. The design of the study by Bernstein et al assumes that the RAND protocols alone, without subsequent peer review . . . [Full Text PDF of this Article]

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