Predicting the Appropriate Use of Carotid Endarterectomy, Upper Gastrointestinal Endoscopy, and Coronary Angiography

MAINTAINING the quality of care in an increasingly cost-conscious environment is a goal of many health policy decision makers. The ability to achieve this goal may depend on the ability to determine the medical appropriateness of care. We define a procedure or service as appropriate if its health be...

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Bibliographic Details
Published inThe New England journal of medicine Vol. 323; no. 17; pp. 1173 - 1177
Main Authors Brook, Robert H, Park, Rolla Edward, Chassin, Mark R, Solomon, David H, Keesey, Joan, Kosecoff, Jacqueline
Format Journal Article
LanguageEnglish
Published United States Massachusetts Medical Society 25.10.1990
Subjects
Aged
Angina pectoris
Angiography
Angiography - utilization
Carotid Arteries - surgery
Carotid Artery Diseases - surgery
Coronary Angiography
Endarterectomy - utilization
Endoscopy
Endoscopy, Gastrointestinal - utilization
Female
Health care
Health care policy
Health sciences
Health services
Health Services Misuse
Heart surgery
Hospitals
Hospitals - utilization
Humans
Male
Medical imaging
Medical records
Mortality
Multivariate Analysis
Patients
Physicians
Practice Patterns, Physicians' - statistics & numerical data
Quality of Health Care
Ratings & rankings
United States
Utilization Review
United States
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Summary:MAINTAINING the quality of care in an increasingly cost-conscious environment is a goal of many health policy decision makers. The ability to achieve this goal may depend on the ability to determine the medical appropriateness of care. We define a procedure or service as appropriate if its health benefit exceeds its health risk (with the explicit exclusion of cost) by a sufficiently wide margin that the service or procedure is worth performing. Using this definition, we studied three procedures — coronary angiography, upper gastrointestinal endoscopy, and carotid endarterectomy — in a geographically diverse sample of Medicare patients. 1 , 2 We examined only . . .
Bibliography:ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
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ISSN:0028-4793
1533-4406
DOI:10.1056/NEJM199010253231705