Evaluation of an Information System for Kidney Transplantation in Adult and Pediatric Recipients Using the RAND/UCLA Appropriateness Method

Abstract

In the mid-1980s, RAND Corporation and University of California Los Angeles (UCLA) developed the RAND/UCLA Appropriateness Method (RAM) to evaluate the correctness of medical and surgical procedures. In this study, the RAND/UCLA Appropriateness Method was used to evaluate the appropriateness of a dataset concerning kidney transplantation in adult and pediatric recipients for an information system funded by the Italian Ministry of Health. The original dataset was obtained using an interdisciplinary pool of regional experts (n = 60). This dataset held 514 items about kidney transplantation in adult (n = 268) and pediatric (n = 246) recipients. The items were stratified as 3 main groups: pretransplantation items (adult, n = 141; pediatric, n = 122), transplantation items (adult, n = 49; pediatric, n = 45), and early posttransplantation and follow-up items (adult, n = 78; pediatric, n = 79). In the second round, the dataset was subjected to an extraregional panel of independent experts (n = 9) to assess each item using a score ranging from 1 to 9 based on increasing appropriateness. The expert-opinion process returned for adult and pediatric kidney recipient items whole mean scores of 8.52 ± 0.32 and 8.65 ± 0.32, respectively. Overall agreement, uncertainty, and disagreement between experts about item appropriateness concerning adult kidney recipients were 94.6%, 5.4%, and 0%, respectively. For pediatric kidney recipients, overall agreement, uncertainty, and disagreement between experts about item appropriateness were 96.9%, 2.35%, and 0.07%, respectively. This study supported the use of a structured expert-opinion process as an effective strategy to evaluate the appropriateness of large datasets for kidney transplantation in both adult and pediatric recipients.