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Judgment Analysis of Surgeons’ Prioritization of Patients for Elective General Surgery
- Source :
- Medical Decision Making. 26:255-264
- Publication Year :
- 2006
- Publisher :
- SAGE Publications, 2006.
-
Abstract
- Background . Access to elective general surgery in New Zealand is governed by clinicians’ judgment of priority using a visual analog scale (VAS). This has been criticized as lacking reliability and transparency. Our objective was to describe this judgment in terms of previously elicited cues. Methods . We asked 60 general surgeons in New Zealand to assess patient vignettes using 8 VAS scales to determine priority. They then conducted judgment analysis to determine agreement between surgeons. Cluster analysis was performed to identify groups of surgeons who used different cues. Multiple regression for the combined surgeons was undertaken to determine the predictability of the 8-scale VAS. Results . Agreement between surgeons was poor (ra = 0.48). The cause of poor agreement was mostly due to poor consensus (G) between surgeons in how they weighted criteria. Using cluster analysis, we classified the surgeons into 2 groups: 1 took more account of quality of life and diagnosis, whereas the other group placed more weight on the influence of treatment. The 8-scale VAS showed good predictability in assigning a priority score (R 2 = 0.66). Discussion . The level of agreement reflects surgeons’ practice variation. This is exemplified by 2 distinct surgeon groups that differ in how criteria were weighted.
- Subjects :
- Prioritization
medicine.medical_specialty
Visual analogue scale
Disease cluster
Health care rationing
03 medical and health sciences
0302 clinical medicine
Quality of life
Physicians
Humans
Medicine
030212 general & internal medicine
Practice Patterns, Physicians'
Judgment analysis
Pain Measurement
Priority setting
Operative Surgical Procedures
business.industry
030503 health policy & services
Health Policy
General surgery
Elective Surgical Procedures
General Surgery
Workforce
0305 other medical science
business
New Zealand
Subjects
Details
- ISSN :
- 1552681X and 0272989X
- Volume :
- 26
- Database :
- OpenAIRE
- Journal :
- Medical Decision Making
- Accession number :
- edsair.doi.dedup.....cf837c9357f16458bc24e526cfafe8cf