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Health Serv Res. 1995 October; 30(4): 577–591.
PMCID: PMC1070076

Impact of varying panel membership on ratings of appropriateness in consensus panels: a comparison of a multi- and single disciplinary panel.


OBJECTIVE. The objective of the study was to examine the appropriateness ratings for the use of spinal manipulation for low back pain of a multidisciplinary panel of medical and chiropractic physicians, and those of a panel composed only of chiropractic physicians. DATA SOURCES. The study analyzed data from two consensus panels conducted at RAND in 1990 and 1991. STUDY DESIGN. The study design followed that of the traditional RAND consensus panels. Nine individuals comprised each panel, and each panelist was asked to rate, on a nine-point scale, the indications for spinal manipulation twice, the first time alone and the second time jointly with the panel. DATA COLLECTION. The ratings of the panelists from both groups, for both round one and round two, were collated and compared. PRINCIPAL FINDINGS. While both panels were more likely to rate the indications as inappropriate than appropriate, the single disciplinary panel was more likely to rate an indication as appropriate than the multidisciplinary panel. CONCLUSION. The composition of a panel clearly influences the ratings and those who use a given procedure in practice, in this case manipulation, are more likely to rate it as appropriate than those who do not use the procedure.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Andreasen PB. Consensus conferences in different countries. Aims and perspectives. Int J Technol Assess Health Care. 1988;4(2):305–308. [PubMed]
  • Brook RH, Chassin MR, Fink A, Solomon DH, Kosecoff J, Park RE. A method for the detailed assessment of the appropriateness of medical technologies. Int J Technol Assess Health Care. 1986;2(1):53–63. [PubMed]
  • Brook RH, Kosecoff JB, Park RE, Chassin MR, Winslow CM, Hampton JR. Diagnosis and treatment of coronary disease: comparison of doctors' attitudes in the USA and the UK. Lancet. 1988 Apr 2;1(8588):750–753. [PubMed]
  • Brook RH, Park RE, Chassin MR, Solomon DH, Keesey J, Kosecoff J. Predicting the appropriate use of carotid endarterectomy, upper gastrointestinal endoscopy, and coronary angiography. N Engl J Med. 1990 Oct 25;323(17):1173–1177. [PubMed]
  • Calltorp J. Consensus development conferences in Sweden. Effects on health policy and administration. Int J Technol Assess Health Care. 1988;4(1):75–88. [PubMed]
  • Casparie AF, Klazinga NS, van Everdingen JJ, Touw PP. Health-care providers resolve clinical controversies: the Dutch consensus approach. Aust Clin Rev. 1987 Mar;7(24):43–47. [PubMed]
  • Fink A, Brook RH, Kosecoff J, Chassin MR, Solomon DH. Sufficiency of clinical literature on the appropriate uses of six medical and surgical procedures. West J Med. 1987 Nov;147(5):609–614. [PMC free article] [PubMed]
  • Fraser GM, Pilpel D, Kosecoff J, Brook RH. Effect of panel composition on appropriateness ratings. Int J Qual Health Care. 1994 Sep;6(3):251–255. [PubMed]
  • Kahn KL, Park RE, Vennes J, Brook RH. Assigning appropriateness ratings for diagnostic upper gastrointestinal endoscopy using two different approaches. Med Care. 1992 Nov;30(11):1016–1028. [PubMed]
  • Leape LL, Park RE, Kahan JP, Brook RH. Group judgments of appropriateness: the effect of panel composition. Qual Assur Health Care. 1992 Jun;4(2):151–159. [PubMed]
  • Lomas J. Words without action? The production, dissemination, and impact of consensus recommendations. Annu Rev Public Health. 1991;12:41–65. [PubMed]
  • McClellan M, Brook RH. Appropriateness of care. A comparison of global and outcome methods to set standards. Med Care. 1992 Jul;30(7):565–586. [PubMed]
  • Merrick NJ, Fink A, Park RE, Brook RH, Kosecoff J, Chassin MR, Solomon DH. Derivation of clinical indications for carotid endarterectomy by an expert panel. Am J Public Health. 1987 Feb;77(2):187–190. [PubMed]
  • Park RE, Fink A, Brook RH, Chassin MR, Kahn KL, Merrick NJ, Kosecoff J, Solomon DH. Physician ratings of appropriate indications for six medical and surgical procedures. Am J Public Health. 1986 Jul;76(7):766–772. [PubMed]
  • Shekelle PG, Adams AH, Chassin MR, Hurwitz EL, Brook RH. Spinal manipulation for low-back pain. Ann Intern Med. 1992 Oct 1;117(7):590–598. [PubMed]
  • Stocking B. First consensus development conference in United Kingdom: on coronary artery bypass grafting. I. Views of audience, panel, and speakers. Br Med J (Clin Res Ed) 1985 Sep 14;291(6497):713–716. [PMC free article] [PubMed]
  • Vang J. The consensus development conference and the European experience. Int J Technol Assess Health Care. 1986;2(1):65–76. [PubMed]

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