To determine whether training and experience affect the selection of process criteria for evaluating medical care, three groups of physicians (family physicians, general pediatricians, and pediatricians specializing in infectious disease) were sent a questionnaire asking their opinions about various clinical actions in 125 clinical situations concerning respiratory infections in infants. Five hundred and twenty-four (54 per cent) physicians returned completed questionnaires. The three groups agreed in 93 (74 per cent) situations, especially about history taking, physical examination, and follow-up observation. Disagreements occurred most often regarding antibiotic use. Of the three groups, the family physicians selected the most extensive list of recommended actions including the greatest number of indications for antibiotics. The general pediatricians selected the fewest situations requiring history taking, physical examination and diagnostic tests. The infectious-disease pediatricians felt the greatest necessity to record history and physical-examination items but were the most restrictive in recommending antibiotics and other drugs. (N Engl J Med 294:871–876, 1976) The identification of appropriate explicit criteria continues to be a major concern in evaluating the quality of medical care. Payne has cautioned that explicit process criteria are not immutable or absolute values but “are a composite of education, experience, social factors, economics, patient characteristics, disease variables, and personal preferences.”1 These elusive properties have suggested that the acceptance of explicit criteria should at least be contingent upon the attainment of solid consensus. Although several workers have increased the size and diversity of criteria-setting panels to develop broadly acceptable criteria,2 3 4 5 6 most criteria have been developed by small panels of experts, often academic.
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