OBJECTIVE: To summarize the findings of methodological studies on the RAND/University of California Los Angeles (RAND/UCLA) appropriateness method, which was developed to assess if variation in the use of surgical procedures is because of overuse and/or underuse. STUDY DESIGN AND SETTING: A MEDLINE literature search was performed. Studies were included if they assessed the reliability or validity of the RAND/UCLA appropriateness method for a surgical procedure or the effect of altering panelist composition or eliminating in-person discussion between rating rounds. Information was abstracted on procedure, study design, and findings. RESULTS: One thousand six hundred one titles were identified, and 37 met the inclusion criteria. The test-retest reliability is good to very good (kappa, 0.64-0.81) for total knee and hip joint replacement, coronary artery bypass grafting (CABG), and carotid endarterectomy (CEA). The interpanel reliability is moderate to very good (kappa, 0.52-0.83) for CABG and hysterectomy. Construct validity has been demonstrated by comparing the appropriateness method with guidelines and/or evidence-based approaches for endoscopy, colonoscopy, CABG, hysterectomy, and CEA. Predictive validity has been studied for cardiac revascularization, in which concordance with appropriateness classification is associated with better clinical outcomes. CONCLUSION: Our findings support use of the appropriateness method to assess variation in the rates of the procedures studied by identifying overuse and underuse. Further methodological research should be conducted as appropriateness criteria are developed and implemented for a broader range of procedures.
OBJECTIVE: To summarize the findings of methodological studies on the RAND/University of California Los Angeles (RAND/UCLA) appropriateness method, which was developed to assess if variation in the use of surgical procedures is because of overuse and/or underuse. STUDY DESIGN AND SETTING: A MEDLINE literature search was performed. Studies were included if they assessed the reliability or validity of the RAND/UCLA appropriateness method for a surgical procedure or the effect of altering panelist composition or eliminating in-person discussion between rating rounds. Information was abstracted on procedure, study design, and findings. RESULTS: One thousand six hundred one titles were identified, and 37 met the inclusion criteria. The test-retest reliability is good to very good (kappa, 0.64-0.81) for total knee and hip joint replacement, coronary artery bypass grafting (CABG), and carotid endarterectomy (CEA). The interpanel reliability is moderate to very good (kappa, 0.52-0.83) for CABG and hysterectomy. Construct validity has been demonstrated by comparing the appropriateness method with guidelines and/or evidence-based approaches for endoscopy, colonoscopy, CABG, hysterectomy, and CEA. Predictive validity has been studied for cardiac revascularization, in which concordance with appropriateness classification is associated with better clinical outcomes. CONCLUSION: Our findings support use of the appropriateness method to assess variation in the rates of the procedures studied by identifying overuse and underuse. Further methodological research should be conducted as appropriateness criteria are developed and implemented for a broader range of procedures.
Authors: Sachin Wani; V Raman Muthusamy; Nicholas J Shaheen; Rena Yadlapati; Robert Wilson; Julian A Abrams; Jacques Bergman; Amitabh Chak; Kenneth Chang; Ananya Das; John Dumot; Steven A Edmundowicz; Glenn Eisen; Gary W Falk; M Brian Fennerty; Lauren Gerson; Gregory G Ginsberg; David Grande; Matt Hall; Ben Harnke; John Inadomi; Janusz Jankowski; Charles J Lightdale; Jitin Makker; Robert D Odze; Oliver Pech; Richard E Sampliner; Stuart Spechler; George Triadafilopoulos; Michael B Wallace; Kenneth Wang; Irving Waxman; Srinadh Komanduri Journal: Am J Gastroenterol Date: 2017-06-01 Impact factor: 10.864
Authors: David F Schneider; Linda M Cherney Stafford; Nicole Brys; Caprice C Greenberg; Courtney J Balentine; Dawn M Elfenbein; Susan C Pitt Journal: Endocr Pract Date: 2017-01-17 Impact factor: 3.443
Authors: Anne F Mannion; Francine Mariaux; Valérie Pittet; Felix Steiger; Martin Aepli; Tamás F Fekete; Dezső Jeszenszky; Dave O'Riordan; François Porchet Journal: Eur Spine J Date: 2021-02-11 Impact factor: 3.134
Authors: Volker M Tronnier; Sam Eldabe; Jörg Franke; Frank Huygen; Philippe Rigoard; Javier de Andres Ares; Richard Assaker; Alejandro Gomez-Rice; Marco La Grua; Maarten Moens; Lieven Moke; Christophe Perruchoud; Nasir A Quraishi; Dominique A Rothenfluh; Pedram Tabatabaei; Koen Van Boxem; Carmen Vleggeert-Lankamp; Björn Zoëga; Herman J Stoevelaar Journal: Eur Spine J Date: 2018-08-04 Impact factor: 3.134