/appropriateness-bounding

name: appropriateness-bounding
description: Establish acceptability standards through RAND/UCLA Appropriateness Method
  or Consensus Conference protocols.
dependencies:
  tactics:
  - iterative-convergence-round
  - threshold-calibration
  sops:
  - consensus-synthesis

Appropriateness Bounding

**Purpose:** Determine what is appropriate, acceptable, or indicated for a given context. Uses the RAND/UCLA Appropriateness Method (rating + discussion + re-rating) or Consensus Conference (citizen jury) format to establish boundaries of acceptability.

**When to use:**

• Medical guideline development (appropriate indications)
• Regulatory standard setting
• Establishing acceptable thresholds for action
• Any question of the form "is X appropriate when Y?"

Budget

| Parameter | Constraint | |-----------|-----------| | Rounds | 2 (rate → discuss → re-rate) | | Perspectives | ≥4 (ideally 7–15 for RAND/UCLA) | | Rating scale | 1–9 (inappropriate to appropriate) | | Agreement threshold | Median ≥7 without disagreement |

State Ledger

| Key | Type | Description | |-----|------|-------------| | indications | array | List of scenarios to rate | | perspectives | array | Panel member perspectives | | round_1_ratings | array | Initial ratings per indication | | discussion_notes | string | Key points from discussion | | round_2_ratings | array | Post-discussion ratings | | classifications | object | Appropriate/uncertain/inappropriate per item |

Available Tactics

• **iterative-convergence-round** — Two-round rate-discuss-rerate cycle
• **threshold-calibration** — Determine where appropriateness boundaries fall

Available SOPs

• judgment-collection
• feedback-distribution
• consensus-measurement
• round-decision
• threshold-sweep
• consensus-classification
• consensus-synthesis

Execution Guidance

1. Define indications/scenarios clearly (clinical scenarios, use cases) 2. Collect Round 1 ratings (1–9 scale) with brief rationale 3. Distribute feedback showing distribution of ratings 4. Facilitate structured discussion of disagreements 5. Collect Round 2 ratings 6. Classify each indication: appropriate (median 7–9), uncertain (4–6), inappropriate (1–3) 7. Flag items with disagreement (where panel lacks agreement despite median)

Output Format

classifications:
  appropriate: [{indication, median, agreement_level}, ...]
  uncertain: [{indication, median, agreement_level}, ...]
  inappropriate: [{indication, median, agreement_level}, ...]
disagreement_items: [{indication, reason}, ...]
panel_size: <int>
method: RAND/UCLA | Consensus Conference

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Available Tactics

Optional, no fixed order; the final leaf is always a sop.

| Tactic | When to use | | --- | --- | | iterative-convergence-round | Execute one full Delphi round — collect judgments, distribute anonymous feedback, measure consensus, decide whether to continue. | | threshold-calibration | Systematically sweep consensus thresholds to observe which items achieve consensus at what level, producing a threshold-consensus curve. |

Available SOPs

Optional, no fixed order; the final leaf is always a sop.

| SOP | When to use | | --- | --- | | consensus-synthesis | Synthesize all rounds into a final consensus report documenting agreements, dissent, and process. |

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