Health care reform in the United States is likely to fail without fundamental changes in the practice of medicine. What can be done within a year to substantially increase the likelihood that Americans receive appropriate, humane, affordable care? A starting point is to draw on more than 2 decades of empirical research based on the RAND/University of California Los Angeles (UCLA) Appropriateness Method (RUAM) to develop explicit criteria for determining the appropriateness of care. Physicians and patients can use the results from applying this method to make better informed decisions about expensive, elective procedures or diagnostic tests, and the process of developing the criteria will strengthen the clinical evidence base. The RUAM was developed more than 20 years ago in an effort to understand why quality of care in the United States, and in other developed countries, varied substantially.
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