The appropriate use of high-cost, high-risk technologies: the case of total parenteral nutrition.

An assessment of total parenteral nutrition (TPN), a high-cost, high-risk technology, is used to illustrate the importance of technology assessment to quality assessment. A review of the literature suggests that TPN is only sometimes effective and that it actually produces measurable harm by increasing complication rates in certain groups of patients. However, there are strong advocates for its use. The economic and ethical implications of TPN for the quality of care are also discussed at the levels both of the individual and of society. Continuous assessment of health care technologies, particularly those that are high-cost and high-risk, is critical to the overall quality of health care.