Skip to main content Accessibility help
×
Home
Hostname: page-component-55b6f6c457-xklcj Total loading time: 0.399 Render date: 2021-09-24T13:37:08.619Z Has data issue: true Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "metricsAbstractViews": false, "figures": true, "newCiteModal": false, "newCitedByModal": true, "newEcommerce": true, "newUsageEvents": true }

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

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 Scholar
6. Buetow, SA, Sibbald, B, Cantrill, JA et al. , Appropriateness in health care: Application to prescribing. Soc Sci Med. 1997;45:261271.CrossRefGoogle Scholar
7. Caplan, RA, Posner, KL, Cheney, FW. Effect of outcome on physician judgments of appropriateness of care. JAMA. 1991;265:19571960.CrossRefGoogle Scholar
8. Casparie, AF. The ambiguous relationship between practice variation and appropriateness of care: An agenda for further research. Health Policy. 1996;35:247265.CrossRefGoogle Scholar
9. Caulfield, TA. Wishful thinking: Defining “medically necessary” in Canada. Health Law J. 1996;4:6385.Google Scholar
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 Scholar
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 Scholar
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 Scholar
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 Scholar
19. Lavis, JN, Anderson, GM. Appropriateness in health care delivery: Definitions, measurement and policy implications. CMAJ. 1996;154:321328.Google Scholar
20. Lazaro, P, Fitch, K. From universalism to selectivity: Is ‘appropriateness’ the answer? Health Policy. 1996;36:261272.CrossRefGoogle Scholar
21. Leape, LL. Unnecessary surgery. Health Serv Res. 1989;24:351407.Google Scholar
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 Scholar
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 Scholar
27. Phelps, CE. The methodologic foundations of studies of the appropriateness of medical care. N Engl J Med. 1993;329:12411245.CrossRefGoogle Scholar
28. Sackett, DL. Rules of evidence and clinical recommendations on the use of antithrombotic agents. Chest. 1989;95 (Suppl 2):2S-4S.CrossRefGoogle Scholar
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 Scholar
32. Wennberg, JE. Dealing with medical practice variations: A proposal for action. Health Aff (Millwood). 1984;3:632.CrossRefGoogle Scholar
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
35
Cited by

Send article to Kindle

To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Appropriateness of healthcare interventions: Concepts and scoping of the published literature
Available formats
×

Send article to Dropbox

To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

Appropriateness of healthcare interventions: Concepts and scoping of the published literature
Available formats
×

Send article to Google Drive

To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

Appropriateness of healthcare interventions: Concepts and scoping of the published literature
Available formats
×
×

Reply to: Submit a response

Please enter your response.

Your details

Please enter a valid email address.

Conflicting interests

Do you have any conflicting interests? *