The Methodologic Foundations of Studies of the Appropriateness of Medical Care

As health care costs continue to increase rapidly, both health care providers and consumers have expressed concern that the additional resources used for health services do not provide commensurate increases in health benefits. Adding fuel to this concern, a number of disquieting studies have estimated the rates of “inappropriate” use in a variety of settings of a variety of procedures such as coronary angiography, carotid endarterectomy, endoscopy, and coronary-artery bypass graft surgery1–4. The estimated rates of inappropriate treatment have ranged from about 15 to 30 percent, reaching as high as 40 percent for particular procedures at individual institutions. . . .