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Measuring the necessity of medical procedures
J P Kahan1, S J Bernstein, L L Leape
1RAND Health Sciences Program, Santa Monica, CA 90407-2138.
Insights
This study introduces the concept of procedure necessity, defining it as crucial importance for patient health. While necessity often aligns with appropriateness, consensus on necessity ratings was not achieved, highlighting a need for further research.
Area of Science:
- Health Services Research
- Medical Procedure Evaluation
Background:
- Assessing the appropriateness of medical procedures is crucial for quality healthcare.
- The concept of 'necessity' extends appropriateness by defining procedures critical to patient health.
Purpose of the Study:
- To extend the concept of procedure appropriateness to procedure necessity.
- To evaluate necessity and appropriateness ratings for six medical procedures.
Main Methods:
- A modified Delphi panel process was employed, involving recognized clinical leaders.
- Panels included both performers and non-performers of the procedures.
- Ratings for appropriateness and necessity were collected for six procedures.
Main Results:
- Necessity was related to appropriateness for most procedures and panelists but remained distinct.
- The proportion of indications deemed crucial varied consistently across and within procedures.
- Panelists did not reach a consensus on the necessity ratings for the evaluated procedures.
Conclusions:
- Necessity ratings, distinct from appropriateness, offer insights into procedure utilization.
- These ratings can help identify both overuse and underuse (limited access) of medical procedures.
- Further research is recommended to refine consensus-building methods and validate necessity ratings.
Abstract:
This is a report on the extension of the concept of the appropriateness of a procedure to the necessity, or crucial importance, of that procedure. To state that a procedure is crucial means that withholding the procedure would be deleterious to the patient's health. Appropriateness and necessity ratings for six procedures were obtained using a modified Delphi panel process developed in earlier work. Panels were composed of practicing clinicians who were recognized leaders in their fields. The panels included both performers and nonperformers of the procedure under discussion. For most procedures and panelists, necessity was related to appropriateness, but was distinct from it. The proportion of indications for which the procedure was crucial varied in clinically consistent ways both among and within procedures. However, panelists did not achieve a consensus on necessity. Further research is suggested to refine the method to promote consensus and to validate further the ratings of necessity. In conclusion, necessity ratings can be used together with appropriateness ratings to address not only the overuse of procedures, but also to indicate limited access to care through underuse of procedures.