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Users' Guides to the Medical LiteratureXI. How to Use an Article About a Clinical Utilization Review
C. David Naylor, MD, DPhil;
Gordon H. Guyatt, MD, MSc;
Evidence-Based Medicine Working Group;
Antonio L. Dans, MD, MSc;
Leonila F. Dans, MD, MSc;
Paul Glasziou, MB, PhD;
Lee Green, MD, MPH;
Daren Heyland, MD;
Les Irwig, MBBCh, PhD, FFPHM;
Alejandro Jadad, MD;
Thomas B. Newman, MD;
Adrienne G. Randolph, MD;
Geoffrey M. Anderson, MD, PhD
JAMA. 1996;275(18):1435-1439.
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| Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings. |
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CLINICAL SCENARIO
You are a general internist attending a medical advisory committee meeting as the newly appointed chief of staff in a large community hospital affiliated with a major health maintenance organization. A junior administrator presents data showing that the hospital's utilization of percutaneous transluminal coronary angioplasty (PTCA) is high relative to similar-sized centers with similar numbers of interventional cardiologists. He insinuates that unnecessary PTCAs are being done. The cardiologists present are infuriated, and the meeting degenerates into a shouting match. After the hospital chief executive officer brings the meeting back to order, you and the chief of cardiology agree to research the matter independently and report back in 1 week.
THE SEARCH
Raw utilization data are insufficient to assess whether cardiologists at your hospital are using PTCA inappropriately. You need to review their practice in light of criteria for deciding whether each application of PTCA was likely, given a
. . . [Full Text PDF of this Article]
Author Affiliations
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Department of Internal Medicine, University of the Philippines, Manila; Department of Pediatrics, University of the Philippines, Manila; Department of Social and Preventive Medicine, University of Queensland, Herston, Queensland, Australia; Department of Family Practice, University of Michigan, Ann Arbor; Department of Medicine, McMaster University, Hamilton, Ontario; Department of Epidemiology and Biostatistics, School of Public Health, University of Sydney, Sydney, New South Wales, Australia; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario; Department of Laboratory Medicine, University of California at San Francisco.; fellow at the Institute for Health Policy Studies at the University of California at San Francisco; senior scientist at the Institute for Clinical Evaluative Sciences, University of Toronto (Ontario).
From the Institute for Clinical Evaluative Sciences in Ontario, University of Toronto (Ontario) Clinical Epidemiology and Health Care Research Program (Sunnybrook Unit), and the Departments of Medicine and Surgery, University of Toronto (Dr Naylor); and McMaster University Health Sciences Centre, Hamilton, Ontario (Dr Guyatt).
Footnotes
The original list of members (with affiliations) of the Evidence-Based Medicine Working Group appears in the first article of this series (JAMA. 1993;270:2093-2095). A list of new members appears at the end of this article. The following members contributed to this article: Eric Bass, MD, MPH; Hertzel Gerstein, MD, MSc; Daren Heyland, MD, MSc; Ann Holbrook, MD, PharmD, MSc; Virginia Moyer, MD, MPH; Thomas B. Newman, MD; Andrew Oxman, MD, MSc; W. Scott Richardson, MD; Peter Tugwell, MD, MSc; and John Williams, Jr, MD, MHS.
Corresponding author: C. David Naylor, MD, DPhil, FRCPC, Institute for Clinical Evaluative Sciences in Ontario, G-106, Sunnybrook Health Science Centre, 2075 Bayview Ave, North York, Ontario, Canada M4N 3M5.
Reprints: Gordon Guyatt, MD, MSc, McMaster University Health Sciences Centre, 1200 Main St W, Room 2C12, Hamilton, Ontario, Canada L8N 3Z5.
Users' Guides to the Medical Literature section editor: Drummond Rennie, MD, Deputy Editor (West), JAMA.
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