How Coronary Angiography Is Used

Clinical Determinants of Appropriateness

by Mark R. Chassin, Jacqueline Kosecoff, David Solomon, Robert H. Brook


Full Document

FormatFile SizeNotes
PDF file 0.7 MB

Use Adobe Acrobat Reader version 10 or higher for the best experience.


Purchase Print Copy

 FormatList Price Price
Add to Cart Paperback5 pages $20.00 $16.00 20% Web Discount

This Note uses ratings of appropriateness derived from an expert physician panel to measure how appropriately physicians in 1981 performed coronary angiography in a randomly selected, community-based sample of cases in the Medicare population. The authors studied three large geographic areas in three states, representing regions of high and low use. The high-use site had fewer procedures classified as appropriate (72 percent) than either low-use site (77 percent and 81 percent). Over all sites, 17 percent of procedures were classified as inappropriate. Patients in the high-use site were older, had less severe angina, and were less intensively medically treated than patients in either of the low-use sites. Patients without angina who had not undergone exercise testing constituted the most common subgroup of inappropriate cases. Although overall differences in appropriateness were not large, practice differences do exist. The analysis of practice differences among study sites provides the clinical basis for understanding the small, but significant, differences in the appropriateness of use of coronary angiography. The finding of 17 percent inappropriate use may be cause for concern.

This report is part of the RAND Corporation Note series. The note was a product of the RAND Corporation from 1979 to 1993 that reported other outputs of sponsored research for general distribution.

Permission is given to duplicate this electronic document for personal use only, as long as it is unaltered and complete. Copies may not be duplicated for commercial purposes. Unauthorized posting of RAND PDFs to a non-RAND Web site is prohibited. RAND PDFs are protected under copyright law. For information on reprint and linking permissions, please visit the RAND Permissions page.

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.