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

Published online by Cambridge University Press:  04 July 2008

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


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.

Copyright © Cambridge University Press 2008

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