What question did this study set out to answer?

To determine whether geographic variations in procedure utilization rates across counties are driven by differences in inappropriate medical use.

February 2, 1990JAMA

Does inappropriate use explain small-area variations in the use of health care services?

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To determine whether geographic variations in procedure utilization rates across counties are driven by differences in inappropriate medical use.
Audited medical records of Medicare beneficiaries who underwent coronary angiography, carotid endarterectomy, or upper gastrointestinal tract endoscopy in 1981 across 23 adjacent counties in one state.
Assessed appropriateness of procedure indications using predetermined consensus criteria established by an expert physician panel and evaluated correlations with county-level use rates.
County utilization rates per 10,000 Medicare enrollees ranged widely: 13 to 158 for coronary angiography, 5 to 41 for carotid endarterectomy, and 42 to 164 for endoscopy.
Inappropriate use ranged from 8% to 75% for coronary angiography, 0% to 67% for carotid endarterectomy, and 0% to 25% for endoscopy.
Inappropriate use explained 28% of the variance in county utilization rates for coronary angiography, but showed no significant correlation with utilization rates for carotid endarterectomy or endoscopy.

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Implication

Observational study reveals minimal link between procedure inappropriateness and regional utilization in Medicare beneficiaries, indicating inappropriate care does not drive practice variation.

Cite This Study

L. L. Leape (1990) studied this question.

synapsesocial.com/papers/6a0896d2ae7f011b61ddf2f0 https://doi.org/10.1001/jama.263.5.669

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Implication

Observational study reveals minimal link between procedure inappropriateness and regional utilization in Medicare beneficiaries, indicating inappropriate care does not drive practice variation.

Does inappropriate use explain small-area variations in the use of health care services?

Key Points

Discussion

Implication

Cite This Study

Does inappropriate use explain small-area variations in the use of health care services?

Key Points

Discussion

Implication

Cite This Study

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