The Appropriateness of selected medical and surgical procedures

The RAND/UCLA Health Services Utilization Study (HSUS) was conducted in four stages. In the first stage, using data derived from Medicare physician claims, we calculated population-based rates of use in 1981 of many different medical and surgical procedures for 13 large geographic areas across the United States. Large and statistically significant differences were found for most procedures. In the second stage of HSUS, six procedures were selected for further study. We conducted intensive reviews of the medical literature to summarize existing knowledge concerning efficacy, complications, and indications. In the third stage of the project we constructed comprehensive lists of indications for each of the six selected procedures. Using a two round, modified Delphi consensus method, panels of expert physicians rated the appropriateness of performing each procedure for each of its indications. Appropriateness was defined as present to the extent that the expected health benefits of the procedure exceeded its expected risks.