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Appropriateness of the use of cardiovascular procedures: a method and results of this application
Insights
Developing clinically valid appropriateness guidelines using expert judgment and literature review is crucial for optimizing healthcare resource allocation. This method identifies significant amounts of inappropriate care, highlighting areas for improvement in patient treatment.
Area of Science:
- Health Services Research
- Clinical Decision Making
- Medical Economics
Background:
- Healthcare resources in Western countries face competing priorities, impacting allocation.
- Current health resource allocation often misaligns with actual patient needs.
- Ensuring efficient and effective healthcare delivery is a significant challenge.
Purpose of the Study:
- To develop a method for generating clinically valid appropriateness guidelines for medical procedures.
- To combine existing literature evidence with expert physician judgment.
- To address the mismatch between health resource allocation and patient needs.
Main Methods:
- A modified Delphi approach was employed, integrating literature reviews and expert consultations.
- Three rounds of panel ratings were conducted using clinical scenarios (indications).
- Indications were classified as appropriate, uncertain, or inappropriate based on health benefit versus risk.
Main Results:
- Appropriateness guidelines were developed for coronary procedures across four countries.
- Application to individual cases revealed a substantial volume of inappropriate care.
- A significant portion of procedures were deemed inappropriate, indicating a need for intervention.
Conclusions:
- The developed method effectively generates clinically valid appropriateness guidelines.
- The prevalence of inappropriate care necessitates targeted interventions and dissemination strategies.
- Uncertain indications for frequently performed procedures warrant further investigation through controlled clinical trials.
Abstract:
Resources available to provide adequate health care in western countries must compete with other priorities such as education and the environment. At the same time the allocation of health resources often does not correspond to the real needs of patients. We have developed a method that combines what is known in the literature with expert physician judgment to generate clinically valid appropriateness guidelines. The method involves a modified Delphi approach, including a detailed literature review, consultations with experts, and three rounds of panel ratings. Clinical scenarios, or indications, are rated appropriate, uncertain, or inappropriate. Appropriate means that the procedure is worth doing for the given indication if the health benefit exceeds the health risk. We have conducted panels relating to coronary procedures in four countries. Application of the indications to individual cases has demonstrated that the amount of inappropriate care is too large to be ignored. Dissemination of appropriateness results might take the form of public disclosure or as part of the physician/patient exchange to improve performance. Indications for which a procedure is frequently performed and which are rated uncertain should be considered to be the focus of controlled clinical trials.