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Phân loại phù hợp các chỉ dẫn cho các thủ tục tim mạch dựa kiểm toán thực tế trong lĩnh vực này: cross-quốc gia khác nhau trong bảng đánh giá thủ tục chuyên gia về động mạch vành bỏ qua ghép Địa điểm / mẫu Mỹ, 4 bệnh viện ở Washington Nhà nước Vương quốc Anh, | Evidence-based Cardiology Table 8.1 Categorization of appropriateness of indications for cardiovascular procedures based on actual audits in the field cross-national differences in expert panel assessments Procedure Location sample Year n Panel nationality Appropriate Uncertain Inappropriate Coronary artery USA 4 hospitals 1979-80 386 American 62 25 13 bypass graft in Washington State 1979-82 British 41 24 35 UK 3 hospitals in Trent region 1987-88 319 American 67 26 7 British 57 27 16 Canada 13 hospitals in Ontario and 1989-90 556 American 88 9 3 British Columbia Canadian 85 11 4 USA 15 hospitals 1990 1336 American 91 7 2 in New York State Canadian 85 10 6 Coronary USA 4 hospitals in 1979-80 376 American 50 23 27 angiography Washington State 1979-82 British 11 29 60 USA Medicare beneficiaries in 1981 1677 American 74 9 17 3 states British 39 19 42 UK 3 hospitals in Trent region 1987-88 320 American 71 12 17 British 49 30 21 Canada 20 hospitals in Ontario and 1989-90 533 American 77 18 5 British Columbia Canadian 58 33 9 USA 15 hospitals 1990 1333 American 76 20 4 in New York State Canadian 51 39 10 Adapted from Naylor26 The data show the appropriateness ratings for sets of identical patient charts as described. Each set of charts was assessed according to criteria derived by expert panels based in the listed countries. Application and applicability of the audit criteria Application of explicit process-of-care criteria often rests on data derived from retrospective chart reviews by professional auditors. The audit process must therefore be reliable. Biases can be introduced through skewed sampling of practitioners hospitals and patients. Even a meticulous audit however may miss mitigating factors. Thus in many instances if the explicit review shows potential problems with the appropriateness of a service the case is assessed by experienced clinicians to preclude false positives . It is also crucial that enough cases be reviewed to draw robust conclusions. For .
