The Methodologic Foundations of Studies of the Appropriateness of Medical Care

Abstract

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. Ratings of the appropriateness of medical interventions have been used to support practice guidelines, and have been suggested for preoperative screening and even for studies of rates of inappropriate use of interventions by individual physicians. Researchers using indicators of appropriate care have investigated how such indicators are created, but there has been little analysis of the fundamental characteristics of the methods. With this paper I hope to open a discussion of these methods, with the aim of improving them, sharpening their application, and stimulating further research to resolve some of the issues raised here.