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  • International Journal of Technology Assessment in Health Care, Volume 24, Issue 3
  • July 2008, pp. 342-349

Appropriateness of healthcare interventions: Concepts and scoping of the published literature


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.

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1.JZ Ayanian , MB Landrum , SL Normand , E Guadagnoli , BJ McNeil . 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.

2.AE Barnato , AM Garber . Performance of the RAND appropriateness criteria. Med Decis Making. 2003;23:122130.

3.LA Bergthold . Medical necessity: Do we need it? Health Aff (Millwood). 1995;14:180190.

6.SA Buetow , B Sibbald , JA Cantrill , Appropriateness in health care: Application to prescribing. Soc Sci Med. 1997;45:261271.

7.RA Caplan , KL Posner , FW Cheney . Effect of outcome on physician judgments of appropriateness of care. JAMA. 1991;265:19571960.

8.AF Casparie . The ambiguous relationship between practice variation and appropriateness of care: An agenda for further research. Health Policy. 1996;35:247265.

10.C Charles , J Lomas , M Giacomini . Medical necessity in Canadian health policy: Four meanings and . . . a funeral? Milbank Q. 1997;75:365394.

11.WE Ford . Medical necessity and psychiatric managed care. Psychiatr Clin North Am. 2000;23:309317.

12.GM Fraser , D Pilpel , J Kosecoff , Effect of panel composition on appropriateness ratings. Int J Qual Health Care. 1994;6:251255.

14.JR Hampton . Editorial comment – Ideal treatment and appropriate treatment. Int J Cardiol. 2001;78:221223.

15.NR Hicks . Some observations on attempts to measure appropriateness of care. BMJ. 1994;309:730733.

17.JP Kahan , SJ Bernstein , LL Leape , Measuring the necessity of medical procedures. Med Care. 1994;32:357365.

20.P Lazaro , K Fitch . From universalism to selectivity: Is ‘appropriateness’ the answer? Health Policy. 1996;36:261272.

22.LL Leape , RE Park , DH Solomon , Does inappropriate use explain small-area variations in the use of health-care services. JAMA. 1990;263:669672.

23.M McClellan , RH Brook . Appropriateness of care. A comparison of global and outcome methods to set standards. Med Care. 1992;30:565586.

24.CD Naylor . What is appropriate care? N Engl J Med. 1998;338:19181920.

25.RE Park , A Fink , RH Brook , Physician ratings of appropriate indications for six medical and surgical procedures. Am J Public Health. 1986;76:766772.

26.MV Pauly . What is unnecessary surgery? Milbank Mem Fund Q Health Soc. 1979;57:95117.

27.CE Phelps . The methodologic foundations of studies of the appropriateness of medical care. N Engl J Med. 1993;329:12411245.

28.DL Sackett . Rules of evidence and clinical recommendations on the use of antithrombotic agents. Chest. 1989;95 (Suppl 2):2S-4S.

29.VA Sharpe . The politics, economics, and ethics of “appropriateness”. Kennedy Inst Ethics J. 1997;7:337343.

30.VA Sharpe , AI Faden . Appropriateness in patient care: A new conceptual framework. Milbank Q. 1996;74:115138.

31.P Shekelle . The appropriateness method. Med Decis Making. 2004;24:228231.

32.JE Wennberg . Dealing with medical practice variations: A proposal for action. Health Aff (Millwood). 1984;3:632.

34.RS Woodward , F Warren-Boulton . Considering the effects of financial incentives and professional ethics on ‘appropriate’ medical care. J Health Econ. 1984;3:223237.

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International Journal of Technology Assessment in Health Care
  • ISSN: 0266-4623
  • EISSN: 1471-6348
  • URL: /core/journals/international-journal-of-technology-assessment-in-health-care
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