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Questions and Answers

JAMA. 1990;264(1):89-92. doi:10.1001/jama.1990.03450010093039.
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The categories for response to a DATTA question are defined as follows: Established—this technology has been adequately evaluated and its (A) safety or (B) effectiveness is accepted as appropriate by the practicing medical community for the given indication in the speciified patient population; promising—given current knowledge, the (A) safety or (B) effectiveness of this technology appears to be appropriate for the given indication in the specified patient population; as more experience and long-term follow-up are accumulated, this interim rating will change; investigational—there is no consensus on the (A) safety or (B) effectiveness of this technology to date, there is insufficient evidence to determine its appropriateness, or it warrants further study; use of this technology for the given indication in the specified patient population should be confined largely to research protocols; doubtful—given current knowledge, the (A) safety or (B) effectiveness of this technology appears to be inappropriate for the given indication in the specified patient population; as more experience and long-term follow-up are accumulated, this interim rating will change; and unacceptable—the (A) safety or (B) effectiveness of this technology is regarded by the practicing medical community as inappropriate for the given indication in the specified patient population.
For each question, any response category receiving 50% or more of the panel's votes was tested for a consensus by assuming that the DATTA panel is a sample from a broader population of experts. Using exact binomial probabilities, the likelihood of the observed vote was calculated if exactly 50% of the total population of experts support that response for that question. Hence, the null hypothesis is that 50% of all experts support the response, and the alternative, one-tailed, hypothesis is that more than 50% of all experts support the response. Rejection of the null hypothesis, and acceptance of the alternative, was interpreted as evidence of a majority opinion in the total population of experts, and a consensus was achieved. If no consensus was found, the categories were reorganized and reanalyzed. The definitions of "promising" and "established" include the concept of "appropriate," while the "doubtful" and "unacceptable" definitions include the concept of "inappropriate." The original five categories were thus, if necessary, reorganized into three categories, "appropriate," "investigational," and "inappropriate"; an analysis of any category with 50% or more of the vote was performed. P values for the survey responses are as follows: Question 1A, 48 "established" responses out of 49, P<.0001, consensus for established; question 1B, 39 "established" responses out of 49, P<.0001, consensus for established. Question 2A, 38 "established" responses out of 49, P<.0001, consensus for established; question 2B, 26 "inappropriate" responses out of 49, P=.39, no consensus; one respondent offered no opinion for questions 1 and 2.
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