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 on January 01, 1995

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

Read More

Access further information on this document at

This article was published outside of RAND. The full text of the article can be found at the link above.

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.

This report is part of the RAND Corporation External publication series. Many RAND studies are published in peer-reviewed scholarly journals, as chapters in commercial books, or as documents published by other organizations.

Our mission to help improve policy and decisionmaking through research and analysis is enabled through our core values of quality and objectivity and our unwavering commitment to the highest level of integrity and ethical behavior. To help ensure our research and analysis are rigorous, objective, and nonpartisan, we subject our research publications to a robust and exacting quality-assurance process; avoid both the appearance and reality of financial and other conflicts of interest through staff training, project screening, and a policy of mandatory disclosure; and pursue transparency in our research engagements through our commitment to the open publication of our research findings and recommendations, disclosure of the source of funding of published research, and policies to ensure intellectual independence. For more information, visit

The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.