Appropriateness of medical care. Findings, strategies.

Concerns regarding significant levels of inappropriate medical services--as high as 20% or more--continue to influence discussions regarding medical care quality, utilization, and costs. The basis of these concerns are findings from a series of studies of the appropriateness of use of several medical and surgical services provided in the late 1970s and early 1980s--cardiac pacemaker implants, carotid endarterectomy, coronary artery bypass surgery, coronary angiography, and upper gastrointestinal endoscopy. More recent data from Medicare peer review organizations, however, indicate lower levels of unnecessary hospital admissions and medical services. Despite uncertainties regarding the extent of inappropriate care, additional efforts are required to better define appropriate medical care. A promising effort to meet this need is the development of practice parameters, which include practice guidelines and standards.