PMID: 9179719May 1, 1997Paper

Measuring and averting underuse of necessary cardiac procedures: a summary of results and future directions

The Joint Commission Journal on Quality Improvement
R L Kravitz, M Laouri

Abstract

Attempting to explain the marked variation in utilization of medical procedures has vexed health policy analysts for nearly three decades. Most health services research to date has been directed at identifying and reducing excessive utilization. Little attention has been given to underuse of care. THE LOS ANGELES CARDIAC UNDERUSE PROJECT OVERVIEW: A research group at the University of California, Los Angeles (UCLA), performed two separate, published studies seeking to measure underuse of coronary angiography and coronary artery revascu-larization (bypass surgery and angioplasty), two critical links in the chain of care leading from initial diagnosis of coronary artery disease to definitive treatment. In each study, the necessity criteria developed by the panel were used to identify patients needing an invasive procedure. Within this population of patients (sampled predominantly from public hospitals), substantial underuse of clinically necessary coronary angiography (41% without refusers) and revascularization (23% without refusers) was detected. In this select population of patients, receiving a necessary revascularization procedure appeared to both reduce the risk of death and improve quality of life. Despite limitations of t...Continue Reading

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Citations

Dec 18, 2008·BMC Health Services Research·Zhongmin LiEzra A Amsterdam
Jan 5, 2002·The New England Journal of Medicine·B J McNeil

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