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Elizabeth A. McGlynn, PhD; Albert L. Siu, MD; Steven J. Bernstein, MD
RAND

Robert H. Brook, MD
Santa Monica, Calif

JAMA. 1993;270(11):1317-1318.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

In Reply.

—We do not agree that individual case review is the criterion standard for making appropriateness determinations. In fact, no criterion standard exists and there are significant problems with the reliability of implicit peer review.¹ One advantage of the RAND/UCLA approach is that the appropriateness criteria are explicit; disagreements with the criteria can be discussed and results analyzed to determine the sensitivity of conclusions to controversial elements. While we know that some cases might be overturned on peer review because of extenuating clinical circumstances not covered by the guidelines or individual patient preferences, we also know this occurs among patients receiving care for both appropriate and inappropriate indications.

Because of space limitations we did not mention in our "Methods" section that all patients whose care was scored as inappropriate were re-reviewed by a physician researcher to ensure that the data on which the ratings are based were accurate. . . . [Full Text PDF of this Article]

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