This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Social Bookmarking   What's this?

Clinical Determinants of Appropriateness

Mark R. Chassin, MD, MPP, MPH; Jacqueline Kosecoff, PhD; David H. Solomon, MD; Robert H. Brook, MD, ScD

JAMA. 1987;258(18):2543-2547.

Abstract
Using ratings of appropriateness derived from an expert physician panel, we measured how appropriately physicians in 1981 performed coronary angiography in a randomly selected, community-based sample of cases in the Medicare population. We studied large geographic areas (three sites) in three states, representing regions of high and low use. The high-use site had fewer procedures classified as appropriate (72%) than either low-use site (77% and 81%, respectively). Over all sites, 17% of procedures were classified as inappropriate. Patients in the high-use site were older, had less severe angina, and were less intensively medically treated than patients in either of the low-use sites. Patients without angina who had not undergone exercise testing constituted the most common subgroup of inappropriate cases. Although overall differences in appropriateness were not large, practice differences do exist. This analysis of practice differences among study sites provides the clinical basis for understanding the small, but significant, differences in the appropriateness of use of coronary angiography. The finding of 17% inappropriate use may be cause for concern.

(JAMA 1987;258:2543-2547)

Author Affiliations
From the Health Program of The Rand Corp (Drs Chassin and Brook), and Fink and Kosecoff Inc (Dr Kosecoff), Santa Monica, Calif; and the Departments of Medicine (Drs Kosecoff, Solomon, and Brook), and Public Health (Drs Kosecoff and Brook), University of California at Los Angeles.

Footnotes
The opinions, conclusions, and proposals in the text are those of the authors alone and do not necessarily represent the views of any of these organizations, The Rand Corp, or the University of California.

Reprint requests to The Rand Corp, 1700 Main St, PO Box 2138, Santa Monica, CA 90406-2138 (Dr Chassin).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

The appropriateness of use of coronary angiography in Lebanon: implications for health policy
Sibai et al.
Health Policy Plan 2008;23:210-217.
ABSTRACT | FULL TEXT  

Evidence-Based Medicine: A Unified Approach
Eddy
Health Aff (Millwood) 2005;24:9-17.
ABSTRACT | FULL TEXT  

Hypothetical ratings of coronary angiography appropriateness: are they associated with actual angiographic findings, mortality, and revascularisation rate? The ACRE study
Hemingway et al.
Heart 2001;85:672-679.
ABSTRACT | FULL TEXT  

Racial Disparities in Access to Renal Transplantation -- Clinically Appropriate or Due to Underuse or Overuse?
Epstein et al.
NEJM 2000;343:1537-1544.
ABSTRACT | FULL TEXT  

Comparing Generalist and Specialty Care: Discrepancies, Deficiencies, and Excesses
Donohoe
Arch Intern Med 1998;158:1596-1608.
ABSTRACT | FULL TEXT  

Rating the Appropriateness of Coronary Angiography -- Do Practicing Physicians Agree with an Expert Panel and with Each Other?
Ayanian et al.
NEJM 1998;338:1896-1904.
ABSTRACT | FULL TEXT  

The Use and Interpretation of Commercial APC Gene Testing for Familial Adenomatous Polyposis
Giardiello et al.
NEJM 1997;336:823-827.
ABSTRACT | FULL TEXT  

Relationship of Anatomic Disease to Appropriateness Ratings of Coronary Angiography
Noonan et al.
Arch Intern Med 1995;155:1209-1213.
ABSTRACT  

Cost Sharing in Health Insurance -- A Reexamination
Rasell
NEJM 1995;332:1164-1168.
FULL TEXT  

Rx-to-OTC Switch Movement
Rosenau
Med Care Res Rev 1994;51:429-466.
 

The Appropriateness of Performing Coronary Angiography and Coronary Artery Revascularization in a Swedish Population
Bengtson et al.
JAMA 1994;271:1260-1265.
ABSTRACT  

The Quality of Care and the Quality of Measuring It
Kassirer
NEJM 1993;329:1263-1265.
FULL TEXT  

The Association between On-Site Cardiac Catheterization Facilities and the Use of Coronary Angiography after Acute Myocardial Infarction
Every et al.
NEJM 1993;329:546-551.
ABSTRACT | FULL TEXT  

The Appropriateness of Use of Percutaneous Transluminal Coronary Angioplasty in New York State
Hilborne et al.
JAMA 1993;269:761-765.
ABSTRACT  

The Appropriateness of Use of Coronary Angiography in New York State
Bernstein et al.
JAMA 1993;269:766-769.
ABSTRACT  

Toward Fewer Procedures and Better Outcomes
Schoenbaum
JAMA 1993;269:794-796.
ABSTRACT  

The Impact of Social Factors on the Content of Care: Treatment of Ischemic Heart Disease at a Public and a Voluntary Hospital
Yedidia
Arch Intern Med 1992;152:595-600.
ABSTRACT  

Denying Treatment to the Noncompliant Patient
Orentlicher
JAMA 1991;265:1579-1582.
 

Practice Guidelines and Malpractice Litigation: Collision or Cohesion?
Brennan
Journal of Health Politics, Policy and Law 1991;16:67-85.
ABSTRACT  

A Managed Care Approach to Outpatient Review
Lawless
American Journal of Medical Quality 1990;5:53-57.
ABSTRACT  

Does Inappropriate Use Explain Small-Area Variations in the Use of Health Care Services?
Leape et al.
JAMA 1990;263:669-672.
ABSTRACT  

The Politics of Organ Transplantation: A Parable of Our Time
Rettig
Journal of Health Politics, Policy and Law 1989;14:191-227.
ABSTRACT  

Analysis of Physician and Hospital Differences in 'Negative' Coronary Angiogram Rates
Dans et al.
Arch Intern Med 1988;148:2633-2637.
ABSTRACT  

Interhospital Transfer of Acutely Ill Cardiac Patients
Cummins
JAMA 1988;259:1707-1708.
ABSTRACT  

The Paradox of Appropriate Care
Wennberg
JAMA 1987;258:2568-2569.
ABSTRACT  

Practice Variations: A Challenge for Physicians
Dawson
JAMA 1987;258:2570-2570.
ABSTRACT