Developing an Appropriateness Criteria for Knee MRI Using the Rand Appropriateness Method (RAM)-2013

Document Type : RESEARCH PAPER

Authors

1 Health Sciences Research Center, Department of Health and Management, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran

2 Rheumatic Diseases Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

3 Orthopedic Research Center, Mashhad University Of Medical Sciences, Mashhad, Iran

4 Mashhad University of Medical Sciences, Mashhad, Iran

5 Department of Orthopedic Surgery, North Khorasan University of Medical Sciences, Bojnurd, Iran

6 Health Sciences Research Center, Department of Biostatistics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran

7 Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran

8 Student Research Committee, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran

Abstract

 
Background:
Knee pain is one of the most common reasons patients visit their physician. In this regard Magnetic Resonance Imaging (MRI) is the tool of preference for diagnosis. The aim of this study was to determine appropriate guidelines for knee MRI administration using the RAND Appropriateness Method (RAM)-2013
 
Methods:
This qualitative study was done in the Mashhad University of Medical Sciences in 2013. The most appropriate approved knee MRI administration clinical guidelines were evaluated using Guidelines Evaluation and Research Appraisal (AGREE). Panel members consisting of six orthopedic and three rheumatologic doctors gave scores ranging from 1 to 9 for each scenario. The indications were grouped as appropriate, equivocal and inappropriate. Data were analyzed by descriptive statistics and SPSS ver. 18 software.
Results:
Sixty-three scenarios were extracted from the guidelines and then the scenarios were evaluated in 26 indications. Thirty-two (50.79%) cases were considered appropriate, 12 (19.04%) cases uncertain and 19 (30.1%) cases inappropriate.
Conclusions:
The RAND appropriateness method is helpful in identifying the opinion of stakeholders in health care systems. Moreover, making practical use of clinical guidelines can improve patients’ quality of care and prevent unnecessary costs.

Keywords


  1. Habashizadeh T, Heravi MT, Makhmalbaf H, Esmaeeli H. Evaluation of MRI results in clinical suspected ACL tears and its comparison with arthroscopic findings in 100 patients approaching the Ghaem Hospital from 2005 up to 2006. Mashhad: Mashhad University of Medical Sciences; 2007.

  2. Greenberg D, Peterburg Y, Vekstein D, Pliskin JS. Decisions to adopt new technologies at the hospital level: insights from Israeli medical centers. Int J Technol Assess Health Care. 2005;21(2):219-27.

  3. Fuchs VR, Sox HC Jr. Physicians’ views of the relative importance of thirty medical innovations. Health Aff (Millwood). 2001;20(5):30-42.

  4. Passariello R. Cost containment and diffusion of MRI: oil and water?. The situation in Europe. Eur Radiol. 1997;7:259-62.

  5. Hillman AL, Schwartz JS. The diffusion of MRI: patterns of siting and ownership in an era of changing incentives. AJR Am J Roentgenol. 1986;146(5):963-9.

  6. Oh EH, Imanaka Y, Evans E. Determinants of the diffusion of computed tomography and magnetic resonance imaging. Int J Technol Assess Health Care. 2005;21(1):73-80.

  7. Lehnert BE, Bree RL. Analysis of appropriateness of outpatient CT and MRI referred from primary care clinics at an academic medical center: how critical is the need for improved decision support? J Am Coll Radiol. 2010;7(3):192-7.

  8. Salari H, Ostovar R, Esfandiari A, Keshtkaran A, Sari AA, Manesh HY, et al. Evidence for Policy Making: Clinical Appropriateness Study of Lumbar Spine MRI Prescriptions Using RAND Appropriateness Method. Int J Health Policy Manag. 2013;1(1):17-21.

  9. Fitch K, Bernstein SJ, Aguilar MD, Burnand B, LaCalle JR, Lázaro P, et al. The RAND/UCLA Appropriateness Method User’s Manual; 2001.

  10. Ashorkhani M, Gholami Z, Majdzade SR, Maleki K, Nejat S, Nejat S, et al. EBM. Department of Knowledge Translation; 2009.

  11. Effectiveness. Bushehr university of medical sciences2012; Available from: http://www.bpums.ac.ir/fa/DynPages-1156.htm.

  12. Nicollier-Fahrni A, Vader JP, Froehlich F, Gonvers JJ, Burnand B. Development of appropriateness criteria for colonoscopy: comparison between a standardized expert panel and an evidence-based medicine approach. Int J Qual Health Care. 2003;15(1):15-22.

  13. Porchet F, Vader JP, Larequi-Lauber T, Costanza MC, Burnand B, Dubois RW. The assessment of appropriate indications for laminectomy. J Bone Joint Surg Br. 1999;81(2):234-9.

  14. Rezaee Moghadam F, Azma K, Raeesolsadat SA, Saadati N, Shamsodini A, Naseh I. Effect of basic military training on knee pain and flexibility of the muscles surrounding. Journal of Military Medicine. 2006;8(4):260-55.

  15. Irani S, Rashidian A, Yousefi-Nooraie R, Soltani A. Evaluating clinical practice guidelines developed for the management of thyroid nodules and thyroid cancers and assessing the reliability and validity of the AGREE instrument. J Eval Clin Pract. 2011;17(4):729-36.

  16. Piorities and clinical effectiveness forum. MRI and internal knee derangement guideline. 2008; Available at: http://www.derbyshire.nhs.uk/referrals/mri_and_internal_knee_derangement_guideline_2005.pdf

  17. The American College of Radiology. ACR–SSR practice guideline for the performance and interpretation of magnetic resonance imaging (MRI) of the knee. 2010; Available at: http://www.acr.org/Quality-Safety/Standards-Guidelines/Practice-Guidelines-by-Modality/MRI

  18. Salari H, Esfandiari A, Ostovar R, Keshtkaran A. Developing Appropriateness criteria for MRI of Low BackPain(LBP)using Rand Appropriateness Method (RAM). Armaghane-danesh, Yasuj University of Medical Sciences Journal (YUMSJ). 2013;18(2).

  19. Jackson JL, O’Malley PG, Kroenke K. Evaluation of acute knee pain in primary care. Ann Intern Med. 2003;139(7):575-88.

  20. Soltani A, Allameh F, Hoseini M, Froghi N, Sichani BS. Evidence-Based Medicine. Journal of Science and Technology. 2007;1(3).

  21. Jedi FR, Moraveji A, Abazari F. Awareness and use of evidence-based medicine among general practitioners, specialists and residents of areas of the country. Urmia Medical Journal. 2012;23(6).

  22. Kachoei MA, Sdeghizadeh A, Taheri H, Nezhad NK, Pour SM, Kabiri P, et al. Does our clinical decision-making is evidence-based? Jornal of Isfahan Medical School. 2010;28(121).

  23. Nejat S, GHolami Z, Maleki K, Ashorkhani M, Ahghari S, Nejat S, et al. Sources of information used for the knowledge gained by physicians in Tehran. Secretariat of Research and Policy Development; 2009.