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

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.