“Diagostic Agreemet i the Evaluatio of Image-guided Breast Core Needle Biopsies,” America Joural of Surgical Pathology 28（2004）: 126。

即便有快速抗原检测结果：Julie L. Fierro et al., “Variability i the Diagosis, Treatmet of Group A Streptococcal Pharygitis by Primary Care Pediatricias,” Ifectio Cotrol ad Hospital Epidemiology 35, o. S3（2014）: S79。

就会被诊断为患有糖尿病：Diabetes Tests, Ceters for Disease Cotrol ad Prevetio。

在有些医院里，第二诊疗意见是必须给出的：Joseph D. Kroz et al., “Madatory Secod Opiio Surgical Pathology at a Large Referral Hospital,” Cacer 86（1999）: 2426。

达特茅斯·阿特拉斯项目：大部分相关材料可以在网上找到。达特茅斯医学院有像一本书那样长的大纲，The Quality of Medical Care i the Uited States: A Report o the Medicare Program；the Dartmouth Atlas of Health Care 1999（America Hospital Publishers, 1999）。

许多国家也存在医疗资源分配不均的情况：OECD, Geographic Variatios i Health Care:What Do We Kow ad What Ca Be Doe to Improve Health System Performace?（Paris: OECD Publishig, 2014）, 137–169; Michael P. Hurley et al., “Geographic Variatio i Surgical Outcomes ad Cost Betwee the Uited States ad Japa,” America Joural of Maaged Care 22（2016）: 600; Joh Appleby, “Diagostic Agreemet i the Evaluatio of Image-guided Breast Core Needle Biopsies,” America Joural of Surgical Pathology 28（2004）: 126。

即便有快速抗原检测结果：Julie L. Fierro et al., “Variability i the Diagosis, Treatmet of Group A Streptococcal Pharygitis by Primary Care Pediatricias,” Ifectio Cotrol ad Hospital Epidemiology 35, o. S3（2014）: S79。

就会被诊断为患有糖尿病：Diabetes Tests, Ceters for Disease Cotrol ad Prevetio。

在有些医院里，第二诊疗意见是必须给出的：Joseph D. Kroz et al., “Madatory Secod Opiio Surgical Pathology at a Large Referral Hospital,” Cacer 86（1999）: 2426。

达特茅斯·阿特拉斯项目：大部分相关材料可以在网上找到。达特茅斯医学院有像一本书那样长的大纲，The Quality of Medical Care i the Uited States: A Report o the Medicare Program；the Dartmouth Atlas of Health Care 1999（America Hospital Publishers, 1999）。

许多国家也存在医疗资源分配不均的情况：OECD, Geographic Variatios i Health Care:What Do We Kow ad What Ca Be Doe to Improve Health System Performace?（Paris: OECD Publishig, 2014）, 137–169; Michael P. Hurley et al., “Geographic Variatio i Surgical Outcomes ad Cost Betwee the Uited States ad Japa,” America Joural of Maaged Care 22（2016）: 600; Joh Appleby, Veea Raleigh, Fracesca Frosii, Gwy Beva, Haiya Gao, Tom Lyscom, Variatios i Health Care: The Good, the Bad ad the Iexplicable（Lodo: The Kig’s Fud, 2011）。

一项针对放射科医生做出肺炎诊断的研究发现：David C. Cha Jr. et al., “Selectio with Variatio i Diagostic Skill: Evidece from Radiologists,” Natioal Bureau of Ecoomic Research, NBER Workig Paper No. 26467, November 2019。

在医疗领域也是如此：P. J. Robiso, “Radiology’s Achilles’Heel:Error ad Variatio i the Iterpretatio of the Rötge Image,” British Joural of Radiology 70（1997）: 1085。与之相关的一个研究是Yusuke Tsugawa et al., “Physicia Age ad Outcomes i Elderly Patiets i Hospital i the US: Observatioal Study,” BMJ 357（2017）。研究结果发现，医生们越不训练，表现就越糟糕，因此，对于医生来说，在积累实践经验和熟悉最新的证据和指南之间存在一种权衡。这项研究发现，结束住院医师训练后头几年的医生表现最好，因为他们还记得这些证据。

如放射学和病理学：Robiso, “Radiology’s Achilles’ Heel”。

kappa统计量：与相关系数类似，kappa值可以是负的，不过在实践中很少出现。以下是不同kappa统计量的一个特征：轻度吻合（κ=0～0.2），一般吻合（κ=0.21～0.4），中等吻合（κ=0.41～0.6），高度吻合（κ=0.61～0.8），近乎完全吻合（κ＞0.8）。参见Ro Wald, Chaim M. Bell, Rosae Nisebaum, Samuel Perroe, Orfeas Liagos, Veea Raleigh, Fracesca Frosii, Gwy Beva, Haiya Gao, Tom Lyscom, Variatios i Health Care: The Good, the Bad ad the Iexplicable（Lodo: The Kig’s Fud, 2011）。

一项针对放射科医生做出肺炎诊断的研究发现：David C. Cha Jr. et al., “Selectio with Variatio i Diagostic Skill: Evidece from Radiologists,” Natioal Bureau of Ecoomic Research, NBER Workig Paper No. 26467, November 2019。

在医疗领域也是如此：P. J. Robiso, “Radiology’s Achilles’Heel:Error ad Variatio i the Iterpretatio of the Rötge Image,” British Joural of Radiology 70（1997）: 1085。与之相关的一个研究是Yusuke Tsugawa et al., “Physicia Age ad Outcomes i Elderly Patiets i Hospital i the US: Observatioal Study,” BMJ 357（2017）。研究结果发现，医生们越不训练，表现就越糟糕，因此，对于医生来说，在积累实践经验和熟悉最新的证据和指南之间存在一种权衡。这项研究发现，结束住院医师训练后头几年的医生表现最好，因为他们还记得这些证据。

如放射学和病理学：Robiso, “Radiology’s Achilles’ Heel”。

kappa统计量：与相关系数类似，kappa值可以是负的，不过在实践中很少出现。以下是不同kappa统计量的一个特征：轻度吻合（κ=0～0.2），一般吻合（κ=0.21～0.4），中等吻合（κ=0.41～0.6），高度吻合（κ=0.61～0.8），近乎完全吻合（κ＞0.8）。参见Ro Wald, Chaim M. Bell, Rosae Nisebaum, Samuel Perroe, Orfeas Liagos, Adreas Laupacis, Bertrad L. Jaber, “Iterobserver Reliability of Urie Sedimet Iterpretatio,” Cliical Joural of the America Society of Nephrology 4, o. 3（March 2009）: 567–571。

药物之间的相互作用：Howard R. Strasberg et al., “Iter-Rater Agreemet Amog Physicias o the Cliical Sigificace of Drug-Drug Iteractios,” AMIA Aual Symposium Proceedigs （2013）: 1325。

肾病专家们在基于肾病患者的标准化检测结果做出诊断时：Wald et al., “Iterobserver Reliability of Urie Sedimet Iterpretatio”。

乳腺病变是否为癌变：Jua P. Palazzo et al., “Hyperplastic Ductal ad Lobular Lesios ad Carciomas i Situ of the Breast: Reproducibility of Curret Diagostic Criteria Amog Commuity-ad Academic-Based Pathologists,” Breast Joural 4（2003）: 230。

在诊断乳腺增生病变时：Rohit K. Jai et al., “Atypical Ductal Hyperplasia: Iterobserver ad Itraobserver Variability,” Moder Pathology 24（2011）: 917。

判断椎管的狭窄程度：Alex C. Speciale et al., “Observer Variability i Assessig Lumbar Spial Steosis Severity o Magetic Resoace Imagig ad Its Relatio to Cross-Sectioal Spial Caal Area,”Spie 27（2002）: 1082。

在美国，心脏病是男性和女性的主要致死原因：Ceters for Disease Adreas Laupacis, Bertrad L. Jaber, “Iterobserver Reliability of Urie Sedimet Iterpretatio,” Cliical Joural of the America Society of Nephrology 4, o. 3（March 2009）: 567–571。

药物之间的相互作用：Howard R. Strasberg et al., “Iter-Rater Agreemet Amog Physicias o the Cliical Sigificace of Drug-Drug Iteractios,” AMIA Aual Symposium Proceedigs （2013）: 1325。

肾病专家们在基于肾病患者的标准化检测结果做出诊断时：Wald et al., “Iterobserver Reliability of Urie Sedimet Iterpretatio”。

乳腺病变是否为癌变：Jua P. Palazzo et al., “Hyperplastic Ductal ad Lobular Lesios ad Carciomas i Situ of the Breast: Reproducibility of Curret Diagostic Criteria Amog Commuity-ad Academic-Based Pathologists,” Breast Joural 4（2003）: 230。

在诊断乳腺增生病变时：Rohit K. Jai et al., “Atypical Ductal Hyperplasia: Iterobserver ad Itraobserver Variability,” Moder Pathology 24（2011）: 917。

判断椎管的狭窄程度：Alex C. Speciale et al., “Observer Variability i Assessig Lumbar Spial Steosis Severity o Magetic Resoace Imagig ad Its Relatio to Cross-Sectioal Spial Caal Area,”Spie 27（2002）: 1082。

在美国，心脏病是男性和女性的主要致死原因：Ceters for Disease Cotrol ad Prevetio, “Heart Disease Facts,” accessed Jue 16, 2020。

这种情况发生的可能性为31%：Timothy A. DeRoue et al., “Variability i the Aalysis of Coroary Arteriograms,” Circulatio 55（1977）: 324。

这些医生在判断子宫内膜异位病灶的数量和位置时，产生了很大分歧：Olaf Buchweltz et al., “Iterobserver Variability i the Diagosis of Miimal ad Mild Edometriosis,” Europea Joural of Obstetrics & Gyecology ad Reproductive Biology 122（2005）: 213。

肺结核诊断中依然存在显著的变异性：Jea-Pierre Zellweger et al., “Itra-observer ad Overall Agreemet i the Radiological Assessmet of Tuberculosis,” Iteratioal Joural of Tuberculosis & Lug Disease 10（2006）: 1123。关于“一般”诊断一致性的内容，参见Yaia Balabaova et al., “Variability i Iterpretatio of Chest Radiographs Amog Russia Cliicias ad Implicatios for Screeig Programmes:Observatioal Study,” BMJ 331（2005）: 379。

不同国家的放射科医生在肺结核的诊断上也存在差异：Shisaku Sakurada et al., “Iter-Rater Agreemet i the Assessmet of Abormal Chest X-Ray Fidigs for Tuberculosis Betwee Two Asia Coutries,” BMC Ifectious Diseases 12, article 31（2012）。

研究人员要求8位病理学家对每个病例进行诊断：Eva R. Farmer et al., “Discordace i the Histopathologic Diagosis of Melaoma ad Cotrol ad Prevetio, “Heart Disease Facts,” accessed Jue 16, 2020。

这种情况发生的可能性为31%：Timothy A. DeRoue et al., “Variability i the Aalysis of Coroary Arteriograms,” Circulatio 55（1977）: 324。

这些医生在判断子宫内膜异位病灶的数量和位置时，产生了很大分歧：Olaf Buchweltz et al., “Iterobserver Variability i the Diagosis of Miimal ad Mild Edometriosis,” Europea Joural of Obstetrics & Gyecology ad Reproductive Biology 122（2005）: 213。

肺结核诊断中依然存在显著的变异性：Jea-Pierre Zellweger et al., “Itra-observer ad Overall Agreemet i the Radiological Assessmet of Tuberculosis,” Iteratioal Joural of Tuberculosis & Lug Disease 10（2006）: 1123。关于“一般”诊断一致性的内容，参见Yaia Balabaova et al., “Variability i Iterpretatio of Chest Radiographs Amog Russia Cliicias ad Implicatios for Screeig Programmes:Observatioal Study,” BMJ 331（2005）: 379。

不同国家的放射科医生在肺结核的诊断上也存在差异：Shisaku Sakurada et al., “Iter-Rater Agreemet i the Assessmet of Abormal Chest X-Ray Fidigs for Tuberculosis Betwee Two Asia Coutries,” BMC Ifectious Diseases 12, article 31（2012）。

研究人员要求8位病理学家对每个病例进行诊断：Eva R. Farmer et al., “Discordace i the Histopathologic Diagosis of Melaoma ad Melaocytic Nevi Betwee Expert Pathologists,” Huma Pathology 27（1996）: 528。

还有一项研究发现：Alfred W. Kopf, M. Mitzis, ad R. S. Bart，“Diagostic Accuracy i Maligat Melaoma,” Archives of Dermatology 111（1975）: 1291。

这项研究的作者总结道：Maria Miller，A. Berard Ackerma, “How Accurate Are Dermatologists i the Diagosis of Melaoma? Degree of Accuracy ad Implicatios,” Archives of Dermatology 128（1992）: 559。

假阳性率也为1%～64%：Craig A. Beam et al., “Variability i the Iterpretatio of Screeig Mammograms by US Radiologists,” Archives of Iteral Medicie 156（1996）: 209。

有时候，放射科医生两次评估同一张影像片子时会给出不同的意见：P. J. Robiso et al., “Variatio Betwee Experieced Observers i the Iterpretatio of Accidet ad Emergecy Radiographs,” British Joural of Radiology 72（1999）: 323。

血管造影显示的血管阻塞程度：Katherie M. Detre et al., “Observer Agreemet i Evaluatig Coroary Agiograms,” Circulatio 52（1975）: 979。

在那些标准模糊和判断情境复杂的领域中：Horto et al., “Iter- ad Itra-Rater Reliability”;ad Mega Baky et al., “Iter- ad Itra-Melaocytic Nevi Betwee Expert Pathologists,” Huma Pathology 27（1996）: 528。

还有一项研究发现：Alfred W. Kopf, M. Mitzis, ad R. S. Bart，“Diagostic Accuracy i Maligat Melaoma,” Archives of Dermatology 111（1975）: 1291。

这项研究的作者总结道：Maria Miller，A. Berard Ackerma, “How Accurate Are Dermatologists i the Diagosis of Melaoma? Degree of Accuracy ad Implicatios,” Archives of Dermatology 128（1992）: 559。

假阳性率也为1%～64%：Craig A. Beam et al., “Variability i the Iterpretatio of Screeig Mammograms by US Radiologists,” Archives of Iteral Medicie 156（1996）: 209。

有时候，放射科医生两次评估同一张影像片子时会给出不同的意见：P. J. Robiso et al., “Variatio Betwee Experieced Observers i the Iterpretatio of Accidet ad Emergecy Radiographs,” British Joural of Radiology 72（1999）: 323。

血管造影显示的血管阻塞程度：Katherie M. Detre et al., “Observer Agreemet i Evaluatig Coroary Agiograms,” Circulatio 52（1975）: 979。

在那些标准模糊和判断情境复杂的领域中：Horto et al., “Iter- ad Itra-Rater Reliability”;ad Mega Baky et al., “Iter- ad Itra-