Kahan JP; International Society of Technology Assessment in Health Care. Meeting.

Annu Meet Int Soc Technol Assess Health Care Int Soc Technol Assess Health Care Meet. 1997; 13: 87.

RAND Europe, Delft, the Netherlands.

Faced with a need to determine the criteria for the appropriate use of procedures, health services researchers in a number of European countries have been turning to the RAND appropriateness method (RAM) to provide policy makers information about the nature and extent of both overuse and underuse of frequent and/or expensive medical and surgical procedures. The centrepoint of the RAM is a modified Delphi expert panel whose inputs are a thorough review of the scientific literature and the clinical judgement of experienced and respected practitioners and whose output is a rating of the appropriateness and necessity of the procedure for every member of a comprehensive list of its indications. These ratings are then set against data regarding actual usage to determine the appropriateness if the procedure's use. The experience of the researchers has brought awareness of a need to modify the method, in order to improve its reliability, consistency, and ease of use. A BIOMED II Concerted Action project links the principal European users of the method, in order to co-ordinate the needed methodological improvements. These methodological issues are beyond the scope manageable by any research centre, but a co-ordinated effort across centres will speed the needed refinements. A second objective of the concerted action is to learn the degree to which countries can benefit from each other's and joint use of the RAM. If countries can combine efforts to study the inappropriateness and necessity of medical procedures of mutual importance, then there are significant economies of scale to be gained for all parties. The concerted action will construct a co-ordinated supra-study design for RAM studies, maintain a clearing house on appropriateness methodology, and provide mutual support for new applications of the RAM. In addition, it will conduct multi-national panels of several procedures, develop internet methods for obtaining case results and dissemination of criteria for appropriateness and necessity, and develop a curriculum for teaching health professionals how to improve the quality of care by making effective use of medical records. Methodological improvements that will be assessed in the concerted action include refining the review of the scientific literature, building more efficient lists of indications of procedures, and improved data handling. The project will also further assess the conditions favoring reliable and valid use of the method.

Publication Types:

• Meeting Abstracts

Keywords:

• Evaluation Studies
• Health Services Needs and Demand
• Medical Records
• methods
• hsrmtgs

Other ID:

• HTX/98601566

UI: 102233107

From Meeting Abstracts