As health care costs continue to rise, budgets continue to fall, and health consumers gain greater access to reliable information on disease conditions and interventions, there is an increased need to determine what is appropriate health management to ensure quality and responsible healthcare. Advances in technology have increased the number and types of surgical/medical interventions available to health clients. Are inappropriate interventions offered on a regular basis? Is the prescribed intervention the most appropriate? This paper introduces the topic of appropriateness in evidenced-based healthcare and discusses how appropriateness can be assessed. What is appropriateness?
Appropriateness is defined as suitable or fitting for a particular purpose, person or occasion (Webster, 1989). Appropriateness in healthcare is determined when the client's expected health benefits exceed the expected health risks by a substantial margin, exclusive of cost (RAND, 2001) or a balance between doing good against doing harm (Muir Gray, 1997). According to Muir Gray (1997, p.147), "a study of appropriateness is designed to reveal whether the right patient is given the right treatment at the right time by the right professional in the right place". It is important to note that appropriateness is a subjective measure of outcomes of healthcare. Quality of care outcomes refers to correctness and appropriateness and is demonstrated by the decisions concerning the need for medical and surgical intervention. Evidence of appropriateness in healthcare is needed to improve health outcomes, balance costs, provide guidance to physicians and meet the need of the new informed health consumer. Appropriateness is unlike effectiveness. Effectiveness refers to the degree in which an intervention achieves the objectives set (Muir Gray, 1997). One criterion of appropriateness is that of necessity. RAND Corporation has defined necessary as an intervention that is appropriate, would be improper not to make available and would be of significant benefit to the client (Muir Gray, 1997). As technology and improved methods of care are advanced, access to appropriate interventions should improve. Today some interventions are still limited such as magnetic resonance imaging (MRI) in rural communities. Because access is limited, a criterion of necessity is used to determine who is able to access and how quickly. Therefore although use of MRI may be appropriate in diagnostics, it may be underused. Advancements in technology, interventions and clinical research will provide updated evidence which in turn would affect ratings of appropriateness (Muir Gray, 1997).
Methods to determine appropriateness
Methods to determine appropriateness are not only useful in determining what is appropriate care but also what is inappropriate care. It can assist in eliminating underuse and overuse of clinical interventions. Because appropriateness is subjective, it can be difficult to measure. There is no one way or tool to determine the appropriateness of an intervention. Evidence can be assessed retrospectively, after the intervention has occurred, or prospectively, prior to the intervention and used to make a decision on which intervention to use. Evidence on appropriateness is most beneficial to local populations (Muir Gray, 1997). There are three main methods available to determine appropriateness. These include outcomes research, clinical guidelines and the RAND/UCLA appropriateness method. Outcomes research
Outcomes research examines the end results of the healthcare intervention and provides evidence on the risks, benefits and results of the intervention (AHRQ, n.d.). Outcomes can refer to patient satisfaction, change in function or effectiveness of intervention. Research outcomes can provide evidence to make informed decisions and lead to improved quality of care. The Agency for Healthcare Research and Quality (AHRQ) provides research...