Clinical investigations: Outcomes, health policy, and managed careClinically important differences in health status for patients with heart disease: an expert consensus panel report☆
Section snippets
Methods
The RAND Appropriateness Method served as the model for the development and implementation of our consensus panel process. In its original form, the method involved a systematic review of relevant literature, a procedure for expert panelists' selection, a detailed clinical indications list, and then a 2-fold process for consensus building among the expert panelists that integrated current evidence when recommending the appropriateness of surgical and medical procedures.16 With minor
Results
The CAD/CHF expert consensus panel (see Acknowledgments for panelist names) convened in St. Louis, Mo, on May 16, 2000. After initial introductions, the panelists engaged in discussion on their objective to establish small, moderate, and large intraindividual CID standards for both improvements and declines in the CHQ and the SF-36. The panel chair launched the CID dialogue by asking each panelist to give a description of the method he used to determine the CID standards in the Delphi rounds.
Discussion
The RAND Appropriateness Method was used to provide a structured mechanism for convening an expert panel of physicians familiar with the use of the CHQ and the SF-36 in patients with heart disease and to recommend CID standards for these health status measures. The standards recommended by the expert panel for the CHQ were slightly higher than the small, moderate, and large important difference standards ascertained by Jaeschke et al in 1989 of 2.5, 2.0, and 3.5 in the dyspnea, fatigue, and
Acknowledgements
We thank the members of Heart Disease Expert Panel: John A. Spertus, MD, panel chair; Kirkwood F. Adams, MD; Ronald S. Baigrie, MD; Marshall H. Chin, MD; Donald J. Mertens, MD; Michael W. Rich, MD; Kenneth Rockwood, MD; Roy J. Shephard, MD; and Robert J. Zalenski, MD. We also thank Kelli Norton and Joe Kesterson for coordinating the data and chart searches required to create the clinical change scenarios, Janet Bafia and Sharon Fryer for transcribing the audio and videotapes from the panel
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Supported by grants from the Agency for Healthcare Research and Quality to Dr Wolinsky (R01 HS10234) and Dr Wyrwich (K02 HS11635).