The RAND/AMA/AMCC Clinical Appropriateness Initiative: insights for multi-site appropriateness studies derived from the abdominal aortic aneurysm surgery project.

This paper describes a collaborative effort among several organizations in the United States (the RAND/American Medical Association (AMA/Academic Medical Center Consortium (AMCC) Clinical Appropriateness Initiative) and presents, as an illustrative example, one of the four projects of this initiative, the abdominal aortic aneurysm surgery project that was directed by the author. The Clinical Appropriateness Initiative was conceived as a long-term program to develop and maintain a current set of clinical practice guidelines that would play an integral role in enhancing the quality of care delivered in the USA. However, several problems were encountered in its inception that ultimately resulted in early termination of the project. The primary reason for the demise of the abdominal aortic aneurysm surgery project and the other components of the Clinical Appropriateness Initiative was failure to enlist the support of AMCC clinical leaders prior to initiating the project. Numerous opportunities to optimize the generation and implementation of the practice guidelines for the intention of improving health care quality were identified during the conduct of the Clinical Appropriateness Initiative. Health care quality improvement initiatives throughout Europe may benefit from the RAND/AMA/AMCC experience and have the ability to address many of the scientific and policy issues raised by the Clinical Appropriateness Initiative.