The RAND-UCLA appropriateness method was developed as a pragmatic solution to assess the appropriateness of surgical and medical procedures when literature review alone is insufficient.
I this issue of Medical Decision Making, Taffe and colleagues describe a study of the clinical and economic factors influencing the assessments of appropriateness made by clinicians as part of an application of the RAND-UCLA appropriateness method for assessing the use of preoperative erythropoietin in elective orthopedic surgery. Since some readers of the journal may not be familiar with the appropriateness method, in this space I will discuss the development of the appropriateness method, how it is applied, and some of what is known about its utility and validity. The appropriateness method was developed as a pragmatic solution to theproblemof trying to assess for what patients certain surgical and medical procedures are “appropriate.” In this context, appropriate means that the benefits sufficiently exceed the risks and that the procedure is worth doing. Twenty years ago, descriptions of geographic variations in the use of procedures were achieving widespread visibility, and a hypothesis of the timewas that any rate of use higher than the lowest identified rate probably represented “inappropriate” overuse of the procedure at the higher use sites. Investigators at RAND and UCLA set out to test this hypothesis hoping to compare the rate of appropriate and inappropriate use at highand low-use geographic sites, assuming that the determination of what is appropriateuse for aprocedure couldbemade froma thorough review of themedical literature. Having been disabused of this notion after examining the literature on 6 procedures, the investigators were left with the problem of how to make such assessments. Several fundamental concepts helped shape their solution:
Paul Shekelle (Mon,) reported a editorial. RAND-UCLA appropriateness method was evaluated. The RAND-UCLA appropriateness method was developed as a pragmatic solution to assess the appropriateness of surgical and medical procedures when literature review alone is insufficient.