Hostname: page-component-7c8c6479df-nwzlb Total loading time: 0 Render date: 2024-03-27T18:58:31.126Z Has data issue: false hasContentIssue false

Appropriateness of healthcare interventions: Concepts and scoping of the published literature

Published online by Cambridge University Press:  04 July 2008

Claudia Sanmartin
Affiliation:
University of Calgary and Statistics Canada
Kellie Murphy
Affiliation:
Statistics Canada
Nicole Choptain
Affiliation:
University of Regina
Barbara Conner-Spady
Affiliation:
University of Calgary
Lindsay McLaren
Affiliation:
University of Calgary
Eric Bohm
Affiliation:
University of Manitoba and Concordia Hospital
Michael J. Dunbar
Affiliation:
Dalhousie University and QE II Health Sciences Centre
Suren Sanmugasunderam
Affiliation:
University of British Columbia
Carolyn De Coster
Affiliation:
University of Calgary and Calgary Health Region
John McGurran
Affiliation:
University of Toronto
Diane L. Lorenzetti
Affiliation:
University of Calgary and Institute of Health Economics
Tom Noseworthy
Affiliation:
University of Calgary

Abstract

Objectives: This report is a scoping review of the literature with the objective of identifying definitions, conceptual models and frameworks, as well as the methods and range of perspectives, for determining appropriateness in the context of healthcare delivery.

Methods: To lay groundwork for future, intervention-specific research on appropriateness, this work was carried out as a scoping review of published literature since 1966. Two reviewers, with two screens using inclusion/exclusion criteria based on the objective, focused the research and articles chosen for review.

Results: The first screen examined 2,829 abstracts/titles, with the second screen examining 124 full articles, leaving 37 articles deemed highly relevant for data extraction and interpretation. Appropriateness is defined largely in terms of net clinical benefit to the average patient and varies by service and setting. The most widely used method to assess appropriateness of healthcare services is the RAND/UCLA Model. There are many related concepts such as medical necessity and small-areas variation.

Conclusions: A broader approach to determining appropriateness for healthcare interventions is possible and would involve clinical, patient and societal perspectives.

Type
GENERAL ESSAYS
Copyright
Copyright © Cambridge University Press 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1. Ayanian, JZ, Landrum, MB, Normand, SL, Guadagnoli, E, McNeil, BJ. Rating the appropriateness of coronary angiography – do practicing physicians agree with an expert panel and with each other? N Engl J Med. 1998;338:18961904.CrossRefGoogle Scholar
2. Barnato, AE, Garber, AM. Performance of the RAND appropriateness criteria. Med Decis Making. 2003;23:122130.CrossRefGoogle ScholarPubMed
3. Bergthold, LA. Medical necessity: Do we need it? Health Aff (Millwood). 1995;14:180190.CrossRefGoogle Scholar
4. Brook, RH, Chassin, MR, Fink, A et al. , A method for the detailed assessment of the appropriateness of medical technologies. Int J Technol Assess Health Care. 1986;2:5363.CrossRefGoogle ScholarPubMed
5. Brook, RH, Kamberg, CJ. Appropriateness of the use of cardiovascular procedures: A method and results of this application. Schweiz Med Wochenschr. 1993;123:249253.Google ScholarPubMed
6. Buetow, SA, Sibbald, B, Cantrill, JA et al. , Appropriateness in health care: Application to prescribing. Soc Sci Med. 1997;45:261271.CrossRefGoogle ScholarPubMed
7. Caplan, RA, Posner, KL, Cheney, FW. Effect of outcome on physician judgments of appropriateness of care. JAMA. 1991;265:19571960.CrossRefGoogle ScholarPubMed
8. Casparie, AF. The ambiguous relationship between practice variation and appropriateness of care: An agenda for further research. Health Policy. 1996;35:247265.CrossRefGoogle ScholarPubMed
9. Caulfield, TA. Wishful thinking: Defining “medically necessary” in Canada. Health Law J. 1996;4:6385.Google ScholarPubMed
10. Charles, C, Lomas, J, Giacomini, M. Medical necessity in Canadian health policy: Four meanings and . . . a funeral? Milbank Q. 1997;75:365394.CrossRefGoogle Scholar
11. Ford, WE. Medical necessity and psychiatric managed care. Psychiatr Clin North Am. 2000;23:309317.CrossRefGoogle ScholarPubMed
12. Fraser, GM, Pilpel, D, Kosecoff, J et al. , Effect of panel composition on appropriateness ratings. Int J Qual Health Care. 1994;6:251255.CrossRefGoogle ScholarPubMed
13. Greer, AL, Goodwin, JS, Freeman, JL et al. , Bringing the patient back in: Guidelines, practice variations, and the social context of medical practice. Int J Technol Assess Health Care. 2002;18:747761.CrossRefGoogle Scholar
14. Hampton, JR. Editorial comment – Ideal treatment and appropriate treatment. Int J Cardiol. 2001;78:221223.CrossRefGoogle Scholar
15. Hicks, NR. Some observations on attempts to measure appropriateness of care. BMJ. 1994;309:730733.CrossRefGoogle ScholarPubMed
16. Jacobson, PD, Asch, S, Glassman, PA, Model, KE, Hernandez, JB. Defining and implementing medical necessity in Washington State and Oregon. Inquiry. 1997;34:143154.Google ScholarPubMed
17. Kahan, JP, Bernstein, SJ, Leape, LL et al. , Measuring the necessity of medical procedures. Med Care. 1994;32:357365.CrossRefGoogle ScholarPubMed
18. Kosecoff, J, Fink, A, Chassin, MR, Brook, RH. The appropriateness of medical services. Healthspan. 1987;4:1821.Google ScholarPubMed
19. Lavis, JN, Anderson, GM. Appropriateness in health care delivery: Definitions, measurement and policy implications. CMAJ. 1996;154:321328.Google ScholarPubMed
20. Lazaro, P, Fitch, K. From universalism to selectivity: Is ‘appropriateness’ the answer? Health Policy. 1996;36:261272.CrossRefGoogle ScholarPubMed
21. Leape, LL. Unnecessary surgery. Health Serv Res. 1989;24:351407.Google ScholarPubMed
22. Leape, LL, Park, RE, Solomon, DH et al. , Does inappropriate use explain small-area variations in the use of health-care services. JAMA. 1990;263:669672.CrossRefGoogle ScholarPubMed
23. McClellan, M, Brook, RH. Appropriateness of care. A comparison of global and outcome methods to set standards. Med Care. 1992;30:565586.CrossRefGoogle Scholar
24. Naylor, CD. What is appropriate care? N Engl J Med. 1998;338:19181920.CrossRefGoogle ScholarPubMed
25. Park, RE, Fink, A, Brook, RH et al. , Physician ratings of appropriate indications for six medical and surgical procedures. Am J Public Health. 1986;76:766772.CrossRefGoogle ScholarPubMed
26. Pauly, MV. What is unnecessary surgery? Milbank Mem Fund Q Health Soc. 1979;57:95117.CrossRefGoogle ScholarPubMed
27. Phelps, CE. The methodologic foundations of studies of the appropriateness of medical care. N Engl J Med. 1993;329:12411245.CrossRefGoogle ScholarPubMed
28. Sackett, DL. Rules of evidence and clinical recommendations on the use of antithrombotic agents. Chest. 1989;95 (Suppl 2):2S-4S.CrossRefGoogle ScholarPubMed
29. Sharpe, VA. The politics, economics, and ethics of “appropriateness”. Kennedy Inst Ethics J. 1997;7:337343.CrossRefGoogle ScholarPubMed
30. Sharpe, VA, Faden, AI. Appropriateness in patient care: A new conceptual framework. Milbank Q. 1996;74:115138.CrossRefGoogle ScholarPubMed
31. Shekelle, P. The appropriateness method. Med Decis Making. 2004;24:228231.CrossRefGoogle ScholarPubMed
32. Wennberg, JE. Dealing with medical practice variations: A proposal for action. Health Aff (Millwood). 1984;3:632.CrossRefGoogle ScholarPubMed
33. Wennberg, JE, Gittelsohn, A, Shapiro, N. Health care delivery in Maine III: Evaluating the level of hospital performance. J Maine Hosp Assoc. 1975;66:298306.Google ScholarPubMed
34. Woodward, RS, Warren-Boulton, F. Considering the effects of financial incentives and professional ethics on ‘appropriate’ medical care. J Health Econ. 1984;3:223237.CrossRefGoogle ScholarPubMed