In this study, the authors looked at the appropriateness of use of coronary angiography, carotid endarterectomy, and upper gastrointestinal tract endoscopy, and its relationship to geographic variations in the rates of use of these procedures. They selected geographic areas of high, average, and low use of these procedures and randomly sampled Medicare beneficiaries who had received one of the procedures in 1981. The authors determined the indications for the procedures using a detailed review of medical records and previously developed ratings of appropriateness to assign a score to each case. Differences among sites in levels of appropriateness were small. For example, in the high-use site for coronary angiography, 72% of the procedures were appropriate, compared with 81% in the low-use site. Coronary angiography was performed 2.3 times as frequently in the high-use site compared with the low-use site. Under the conditions of this study, the authors found significant levels of inappropriate use: 17% of cases for coronary angiography, 32% for carotid endarterectomy, and 17% for upper gastrointestinal tract endoscopy. The conclusion is that differences in appropriateness cannot explain geographic variations in the use of these procedures.

Originally published in: Journal of the American Medical Association, v. 258, no. 18, November 13, 1987, pp. 2533-2537.

This report is part of the RAND Corporation reprint series. The Reprint was a product of the RAND Corporation from 1992 to 2011 that represented previously published journal articles, book chapters, and reports with the permission of the publisher. RAND reprints were formally reviewed in accordance with the publisher's editorial policy and compliant with RAND's rigorous quality assurance standards for quality and objectivity. For select current RAND journal articles, see External Publications.

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.