Measuring the necessity of medical procedures.

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.

journal_name

Med Care

journal_title

Medical care

authors

Kahan JP,Bernstein SJ,Leape LL,Hilborne LH,Park RE,Parker L,Kamberg CJ,Brook RH

doi

10.1097/00005650-199404000-00004

subject

Has Abstract

pub_date

1994-04-01 00:00:00

pages

357-65

issue

4

eissn

0025-7079

issn

1537-1948

journal_volume

32

pub_type

杂志文章
  • The measurement of expenditures for outpatient physician and dental services: methodological findings from the health insurance study.

    abstract::Survey data measuring outpatient health expenditure are evaluated for item nonresponse, measurement error, and bias. Item nonresponse is high for persons whose health care is financed through the public sector, but is otherwise manageable. Estimates of mean total and out-of-pocket physician and dental expenditure from...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-197611000-00002

    authors: Marquis KH,Marquis MS,Newhouse JP

    更新日期:1976-11-01 00:00:00

  • Labor unions in medicine: the intersection of patient advocacy and self-advocacy.

    abstract:BACKGROUND:Labor unions have been a weak force in the medical marketplace. OBJECTIVES:To briefly review the history of physicians' and nurses' labor unions, explore the ethics of unions in medicine, and offer a solution that simultaneously serves patients and professionals. RESEARCH DESIGN:A selective review of the l...

    journal_title:Medical care

    pub_type: 评论,杂志文章

    doi:10.1097/MLR.0000000000000123

    authors: Manthous CA

    更新日期:2014-05-01 00:00:00

  • 27. CPHA patient care data system for long-term care facilities.

    abstract::Earlier efforts of the Commission on Professional and Hospital Activities (CPHA) to develop a patient care data system for long-term care facilities were discontinued for lack of user interest and shortage of funds; however, the facilities were encouraged to participate in the hospital data system (PAS) and to use opt...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-197605001-00033

    authors: Slee VN

    更新日期:1976-05-01 00:00:00

  • Differential item functioning (DIF) and the Mini-Mental State Examination (MMSE). Overview, sample, and issues of translation.

    abstract:BACKGROUND:Various forms of differential item functioning (DIF) in the Mini-Mental State Examination (MMSE) have been identified. Items have been found to perform differently for individuals of different educational levels, racial/ethnic groups, and/or of groups whose first language is not English. The articles in this...

    journal_title:Medical care

    pub_type: 杂志文章,评审

    doi:10.1097/01.mlr.0000245181.96133.db

    authors: Ramirez M,Teresi JA,Holmes D,Gurland B,Lantigua R

    更新日期:2006-11-01 00:00:00

  • Promoting access and reducing expected out-of-pocket prescription drug costs for vulnerable Medicare beneficiaries: a pharmacist-directed model.

    abstract:BACKGROUND:The Medicare Part D benefit is complicated and may be costly, especially for vulnerable low-income populations where lack of resources and limited English proficiency may be barriers to optimal plan selection. OBJECTIVES:To identify vulnerable Medicare beneficiaries and lower their expected annual out-of-po...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0b013e318202a9f2

    authors: Cutler TW,Stebbins MR,Smith AR,Patel RA,Lipton HL

    更新日期:2011-04-01 00:00:00

  • Assessing the Effectiveness of Complex Interventions to Meet the Needs of VA Stakeholders: Experience of the Department of Veterans Affairs Evidence Synthesis Program.

    abstract:BACKGROUND:Complex health care interventions involve multiple distinct elements that contribute to their functioning. Conducting systematic reviews of complex interventions has substantial challenges. Although methodological guidance exists, less is known about the practical strategies and approaches undertaken by syst...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0000000000001158

    authors: Wilt TJ,Greer N,Duan-Porter W

    更新日期:2019-10-01 00:00:00

  • Interrelationships of physician performances: technical quality and utilization and implications for quality and utilization controls.

    abstract::The study determined the intrarelationships and interrelationships of two sets of physician performance measures: technical quality and utilization of medical resources. The performance measures were based on 2,431 episodes in 15 diagnostic categories involving 454 physicians. A series of correlations were used to det...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:

    authors: Rhee SO,Lyons T,Payne B

    更新日期:1978-06-01 00:00:00

  • The association of attributes of primary care with the delivery of clinical preventive services.

    abstract:OBJECTIVES:Evidence is building that primary care is associated with quality of care and cost effectiveness. Still, little is known of the contribution of specific attributes of primary care to important health outcomes, such as the delivery of preventive services. This study tests the association of specific attribute...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-199808001-00004

    authors: Flocke SA,Stange KC,Zyzanski SJ

    更新日期:1998-08-01 00:00:00

  • Hospital Readmission and Length of Stay Over Time in Patients Undergoing Major Cardiovascular and Orthopedic Surgery: A Tale of 2 States.

    abstract:BACKGROUND:Readmission and length of stay (LOS) are increasingly accepted as quality measures for surgical care. Centers for Medicare & Medicaid Services will soon assess penalties for excessive readmissions after coronary artery bypass graft (CABG) surgery and hip and knee replacements. OBJECTIVE:To determine and com...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0000000000000528

    authors: Sedrakyan A,Kamel H,Mao J,Ting H,Paul S

    更新日期:2016-06-01 00:00:00

  • Overuse and systems of care: a systematic review.

    abstract:BACKGROUND:Current health care reform efforts are focused on reorganizing health care systems to reduce waste in the US health care system. OBJECTIVE:To compare rates of overuse in different health care systems and examine whether certain systems of care or insurers have lower rates of overuse of health care services....

    journal_title:Medical care

    pub_type: 杂志文章,评审

    doi:10.1097/MLR.0b013e31828dbafe

    authors: Keyhani S,Falk R,Howell EA,Bishop T,Korenstein D

    更新日期:2013-06-01 00:00:00

  • Impact of a high-deductible health plan on outpatient visits and associated diagnostic tests.

    abstract:BACKGROUND:By shifting a greater share of out-of-pocket medical costs to consumers, high-deductible health plans (HDHP) might discourage use of essential outpatient services. OBJECTIVE:The objective of the study was to examine the impact of an HDHP on outpatient visits and associated laboratory and radiology tests. R...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0000000000000008

    authors: Reddy SR,Ross-Degnan D,Zaslavsky AM,Soumerai SB,Wharam JF

    更新日期:2014-01-01 00:00:00

  • 15. Canadian experience with patient care classification.

    abstract::Patient care classification in Canada in the past has been largely dictated by insurance coverage and the fiscal policies of the individual provinces. In recent years, however, the Canadian Department of Health and Welfare has been promoting the development of a standard patient care classification based on assessment...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-197605001-00021

    authors: MacDonell JA

    更新日期:1976-05-01 00:00:00

  • Tasks in statistical inference for studying variation in medicine.

    abstract::When studying variation in medicine, traditional hypothesis-testing procedures are too limited to obtain useful inferences except in special situations. More generally, full probability modelling is necessary. Even a relatively simple example can illustrate this point rather dramatically. The development and applicati...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-199305001-00017

    authors: Rubin DB

    更新日期:1993-05-01 00:00:00

  • Patterns of user disclosure of complementary and alternative medicine (CAM) use.

    abstract:OBJECTIVE:To investigate patterns of complementary and alternative medicine (CAM) use disclosure across medical and sociobehavioral factors and to provide a model that takes into account factors in explaining those patterns. SUBJECTS:A total of 21,849 CAM use episodes from 7347 respondents in the 2007 US National Heal...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0000000000000165

    authors: Shim JM,Schneider J,Curlin FA

    更新日期:2014-08-01 00:00:00

  • The two dimensions in satisfaction with dental care.

    abstract::Satisfaction with health services is an aspect of quality of care that is of special importance for captive clients like low-income clinic users. Several methodologies have been reported, but validation has been difficult. This study compares two older scaling techniques with a new, nonmetric method to detect underlyi...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-197803000-00003

    authors: Hengst A,Roghmann K

    更新日期:1978-03-01 00:00:00

  • A severity classification system for AIDS hospitalizations.

    abstract::The authors describe a new model for classifying hospitalized patients with acquired immunodeficiency syndrome (AIDS) according to their severity of illness. In the first phase of the project, a clinical model indicating the relative severity of AIDS complications was formulated, based on the clinical literature and e...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-198904000-00009

    authors: Turner BJ,Kelly JV,Ball JK

    更新日期:1989-04-01 00:00:00

  • Assessing Residual Bias in Estimating Influenza Vaccine Effectiveness: Comparison of High-dose Versus Standard-dose Vaccines.

    abstract:BACKGROUND:Estimating influenza vaccine effectiveness using an unvaccinated comparison group may result in biased effect estimates. OBJECTIVES:To explore the reduction of confounding bias in an active comparison of high-dose versus standard-dose influenza vaccines, as compared with vaccinated versus unvaccinated compa...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0000000000001018

    authors: Butler AM,Layton JB,Krueger WS,Kshirsagar AV,McGrath LJ

    更新日期:2019-01-01 00:00:00

  • Predicting hospital utilization by the elderly. The importance of patient, physician, and hospital characteristics.

    abstract::This study developed an index of physician hospitalization practice style distinguishing physicians more prone to hospitalize patients from physicians less prone to hospitalize. The patients of physicians with markedly differing hospitalization styles are shown to be similar in such important characteristics as age, a...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-198910000-00001

    authors: Roos NP

    更新日期:1989-10-01 00:00:00

  • Nontraditional Surrogate Decision Makers for Hospitalized Older Adults.

    abstract:BACKGROUND:Without advanced preparation of legal documents, state law determines who may serve as a surrogate decision maker for patients in hospitals. OBJECTIVES:To examine the relationship characteristics associated with traditional versus nontraditional health care surrogates who are making medical decisions for pa...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0000000000000890

    authors: Comer AR,Slaven JE,Montz A,Burke E,Inger L,Torke A

    更新日期:2018-04-01 00:00:00

  • A study of central-city hospital changes.

    abstract::This study was initiated to determine the extent of hospital capacity reduction in large U.S. cities. In addition, hospital bed and service additions were analyzed. Study data indicate that between 1976 and 1978 more than 5,000 beds were closed in the 36 cities surveyed. This constitutes 2.7% of total hospital beds in...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-198007000-00004

    authors: Ermann D,Aronoff R

    更新日期:1980-07-01 00:00:00

  • Assessing functional status among elderly patients: a comparison of questionnaire and service provider ratings.

    abstract::This paper describes a comparative analysis of questionnaire-based measures of functional status and clinical ratings of disability made by general practitioners and health visitors. Both approaches to functional assessment were used in rating 92 elderly primary care patients in terms of their performance of 13 mobili...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-197908000-00003

    authors: Kaufert JM,Green S,Dunt DR,Corkhill R,Creese AL,Locker D

    更新日期:1979-08-01 00:00:00

  • Impact of a Medicaid copayment policy on prescription drug and health services utilization in a fee-for-service Medicaid population.

    abstract:BACKGROUND:Copayments (copays) for prescription drugs are a common policy among state Medicaid programs. Research exploring the effects of copays on pharmacy and health care utilization in Medicaid patients is limited, especially among patients with chronic disease. OBJECTIVES:The goal of this research was to quantify...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0b013e3181734a77

    authors: Hartung DM,Carlson MJ,Kraemer DF,Haxby DG,Ketchum KL,Greenlick MR

    更新日期:2008-06-01 00:00:00

  • The impact of the SARS outbreak on an urban emergency department in Taiwan.

    abstract:OBJECTIVE:Emergency departments (ED) were on the front lines for possible cases of transmission during the severe acute respiratory syndrome (SARS) epidemic. The purpose of this study was to investigate the impact of the SARS catastrophe on an urban ED. METHODS:The patients' characteristics in an urban ED were collect...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-200502000-00010

    authors: Chen WK,Cheng YC,Chung YT,Lin CC

    更新日期:2005-02-01 00:00:00

  • Lowering generic drug prices: less regulation equals more competition.

    abstract:BACKGROUND:In Ontario, Canada, the 70/90 regulations were instituted in May 1993 to establish provincial government procurement prices for generic drugs. Accordingly, the first generic entrant's price could not exceed 70% of the incumbent's branded price. Subsequent entrants' prices could not exceed 90% of the first en...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-200301000-00015

    authors: Anis AH,Guh DP,Woolcott J

    更新日期:2003-01-01 00:00:00

  • Evaluation of a cardiopulmonary resuscitation course for secondary schools retention study.

    abstract::A retention study was implemented in Marshfield, Massachusetts in May 1974 in order to ascertain if cardiopulmonary resuscitation (CPR) skills could be retained by secondary school students who had 15 months previously received training in mouth to mouth resuscitation and cardiac compression. The retention study also ...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-197602000-00008

    authors: Vanderschmidt H,Burnap TK,Thwaites JK

    更新日期:1976-02-01 00:00:00

  • Evaluation of the Department of Veterans Affairs community-based outpatient clinics.

    abstract:OBJECTIVE:This paper describes the history of the Department of Veterans Affairs (VA) Community-Based Outpatient Clinics (CBOCs), CBOC Performance Evaluation Project, and characteristics of CBOCs within the VA, and summarizes the findings and implications of the CBOC Performance Evaluation Project. SUBJECTS:There were...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-200207000-00001

    authors: Chapko MK,Borowsky SJ,Fortney JC,Hedeen AN,Hoegle M,Maciejewski ML,VanDeusen Lukas C

    更新日期:2002-07-01 00:00:00

  • Advances in the measurement of functional status: construction of aggregate indexes.

    abstract::This article summarizes tests of the appropriateness of aggregating specific categories of physical capacities and limitations into aggregate functional status indexes. Self-administered questionnaires were used to gather data from 4,603 people between 14 and 66 years of age. Cumulative indexes defining ranked levels ...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-198105000-00001

    authors: Stewart AL,Ware JE Jr,Brook RH

    更新日期:1981-05-01 00:00:00

  • Spiritual care at the end of life in long-term care.

    abstract:BACKGROUND:There is growing attention given to the spiritual needs of dying patients and long-term care (LTC) facilities are common settings in which patients receive care as they approach death. OBJECTIVES:To describe the sources of support, the structure and processes of spiritual care in LTC, and examine the relati...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0b013e3181468b5d

    authors: Daaleman TP,Williams CS,Hamilton VL,Zimmerman S

    更新日期:2008-01-01 00:00:00

  • "Counterintuitive" preferences in health-related quality-of-life measurement.

    abstract::The published preferences for scale steps in a health-related quality-of-life scale have been noted to be contrary to some prior assumptions about their rank ordering. The differences noted are actually statistically nonsignificant, and the observed ordering has a clear intuitive explanation. Several alternative expla...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-198205000-00008

    authors: Bush JW,Anderson JP,Kaplan RM,Blischke WR

    更新日期:1982-05-01 00:00:00

  • Person-centered care practices and quality in Department of Veterans Affairs nursing homes: is there a relationship?

    abstract:OBJECTIVE:To examine variation in culture change to a person-centered care (PCC) model, and the association between culture change and a composite measure of quality in 107 Department of Veterans Affairs nursing homes. METHODS:We examined the relationship between a composite quality measure calculated from 24 quality ...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0b013e3182763230

    authors: Sullivan JL,Shwartz M,Burgess JF Jr,Peköz EA,Christiansen CL,Gerena-Melia M,Berlowitz D

    更新日期:2013-02-01 00:00:00