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Lee H. Hilborne, MD, MPH; Lucian L. Leape, MD; Steven J. Bernstein, MD, MPH; Rolla Edward Park, PhD; Mary E. Fiske, MD; Caren J. Kamberg, MSPH; Carol Pindar Roth, RN, MPH; Robert H. Brook, MD, ScD

JAMA. 1993;269(6):761-765.

Abstract
Objective.
—To determine the appropriateness of use of percutaneous transluminal coronary angioplasty (PTCA) in New York State.

Design.
—Retrospective randomized medical record.

Setting.
—Fifteen randomly selected hospitals in New York State that provide PTCA.

Patients.
—Random sample of 1306 patients undergoing PTCA in New York State in 1990.

Main Outcome Measures.
—Percentage of patients who underwent PTCA for indications rated appropriate, uncertain, and inappropriate.

Results.
—The majority of patients received PTCA for chronic stable angina, unstable angina, and in the post—myocardial infarction period (up to 3 weeks). Fifty-eight percent of PTCAs were rated appropriate; 38%, uncertain; and 4%, inappropriate. The inappropriate rate varied by hospital from 1% to 9% (P=.12); the uncertain rate, from 26% to 50% (P=.02); and the combined inappropriate and uncertain rate, from 29% to 57% (P<.001). There was no difference in appropriateness when the institutions were grouped by volume (fewer than 300 procedures annually or at least 300 procedures annually), location (upstate vs downstate), or by teaching status.

Conclusions.
—Few PTCAs were performed for inappropriate indications in New York State. However, the large number of procedures performed for indications that were rated uncertain as to their net benefit requires further study and justification at both clinical and policy levels.

(JAMA. 1993;269:761-765)

Author Affiliations
From RAND (Drs Hilborne, Leape, Bernstein, Park, Fiske, and Brook, and Ms Kamberg), Santa Monica, Calif; the Departments of Medicine (Drs Hilborne and Brook) and Pathology and Laboratory Medicine (Dr Hilborne), School of Medicine, and the School of Public Health (Dr Brook), UCLA, Los Angeles, Calif; Harvard School of Public Health, Boston, Mass (Dr Leape); the Schools of Medicine and Public Health, University of Michigan, Ann Arbor (Dr Bernstein); and Value Health Sciences Inc, Santa Monica, Calif (Ms Roth).

Footnotes
Reprint requests to RAND, 1700 Main St, Mail Stop 3F, Santa Monica, CA 90406-2398 (Dr Hilborne).

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