Validity of Criteria Used for Detecting Underuse of Coronary Revascularization

Published In: JAMA, The Journal of the American Medical Association, v. 274, no. 8, Aug. 23, 1995, p. 632-638

Posted on RAND.org on December 31, 1994

by Richard L. Kravitz, Marianne Laouri, James P. Kahan, Peter M. Guzy, Todd Sherman, Lee H. Hilborne, Robert H. Brook

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Reports on the validity of criteria used for detecting the underuse of coronary artery bypass surgery (CABS) and percutaneous transluminal coronary angioplasty (PTCA) in terms of patient outcomes. The study included patients from four public and two academically-affiliated private hospitals. A total of 671 patients were identified who received coronary angiography and who met explicit clinical criteria (developed using the RAND/UCLA method) for the necessity of revascularization. Patients who received necessary coronary revascularization within one year of angiography had lower mortality rates than those who did not (9 percent versus 16 percent), and this association persisted after adjustment for sociodemographic and clinical risk variables. The results support the validity of the RAND/UCLA criteria for detecting the underuse of these procedures and emphasize the need to incorporate the evaluation of underuse as well as overuse in health policy.

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