Appropriateness in Health CareEssay Preview: Appropriateness in Health CareReport this essayAppropriateness in Health CareAs health care costs continue to rise, budgets continue to fall, and health consumers gain greater access to reliable information on disease conditions and interventions, there is an increased need to determine what is appropriate health management to ensure quality and responsible healthcare. Advances in technology have increased the number and types of surgical/medical interventions available to health clients. Are inappropriate interventions offered on a regular basis? Is the prescribed intervention the most appropriate? This paper introduces the topic of appropriateness in evidenced-based healthcare and discusses how appropriateness can be assessed.
What is appropriateness?Appropriateness is defined as suitable or fitting for a particular purpose, person or occasion (Webster, 1989). Appropriateness in healthcare is determined when the clients expected health benefits exceed the expected health risks by a substantial margin, exclusive of cost (RAND, 2001) or a balance between doing good against doing harm (Muir Gray, 1997). According to Muir Gray (1997, p.147), “a study of appropriateness is designed to reveal whether the right patient is given the right treatment at the right time by the right professional in the right place”. It is important to note that appropriateness is a subjective measure of outcomes of healthcare. Quality of care outcomes refers to correctness and appropriateness and is demonstrated by the decisions concerning the need for medical and surgical intervention. Evidence of appropriateness in healthcare is needed to improve health outcomes, balance costs, provide guidance to physicians and meet the need of the new informed health consumer.
Appropriateness is unlike effectiveness. Effectiveness refers to the degree in which an intervention achieves the objectives set (Muir Gray, 1997). One criterion of appropriateness is that of necessity. RAND Corporation has defined necessary as an intervention that is appropriate, would be improper not to make available and would be of significant benefit to the client (Muir Gray, 1997).
As technology and improved methods of care are advanced, access to appropriate interventions should improve. Today some interventions are still limited such as magnetic resonance imaging (MRI) in rural communities. Because access is limited, a criterion of necessity is used to determine who is able to access and how quickly. Therefore although use of MRI may be appropriate in diagnostics, it may be underused. Advancements in technology, interventions and clinical research will provide updated evidence which in turn would affect ratings of appropriateness (Muir Gray, 1997).
Methods to determine appropriatenessMethods to determine appropriateness are not only useful in determining what is appropriate care but also what is inappropriate care. It can assist in eliminating underuse and overuse of clinical interventions. Because appropriateness is subjective, it can be difficult to measure. There is no one way or tool to determine the appropriateness of an intervention. Evidence can be assessed retrospectively, after the intervention has occurred, or prospectively, prior to the intervention and used to make a decision on which intervention to use. Evidence on appropriateness is most beneficial to local populations (Muir Gray, 1997). There are three main methods available to determine appropriateness. These include outcomes research, clinical guidelines and the RAND/UCLA appropriateness method.
Outcomes researchOutcomes research examines the end results of the healthcare intervention and provides evidence on the risks, benefits and results of the intervention (AHRQ, n.d.). Outcomes can refer to patient satisfaction, change in function or effectiveness of intervention. Research outcomes can provide evidence to make informed decisions and lead to improved quality of care. The Agency for Healthcare Research and Quality (AHRQ) provides research on outcomes for this purpose. An example of outcomes research can be found at:
Clinical GuidelinesClinical guideline statements are developed from evidence to assist healthcare practitioners in making appropriate health interventions (Woolf, Grol, Hutchinson, Eccles & Grimshaw, 1999). The clinical guideline may be a general statement or concise instruction on which diagnostic test to order or how best to treat a specific condition. The purpose of clinical guidelines is as a tool for making decisions that will result in more consistent and efficient care. Guidelines are not rules nor are they mandatory. The benefits of clinical guidelines include:
Improved health outcomesIncreased beneficial/appropriate careConsistency of careImproved patient informationAbility to positively influence policyProvide direction to health care practitionersPotential limitations of clinical guidelines:The guideline may have been developed from inaccurate evidencePatients need may not be the only priority, the guideline may be used to promote cost-effectiveness or special interests (Woolf et al., 1999).An example of clinical guidelines can be viewed at:RAND/UCLA Method of AppropriatenessRAND is a nonprofit institution that helps improve policy and decision making through research and analysis. The name RAND comes from the combination of the terms research
Research:RAND is a nonprofit research organization, conducting research to understand and promote different behavioral and societal conditions that impact the health of patients, their families, their communities, and their health care delivery systems.RAND is funded by a broad array of federal and state and local grants programs and by grantees and sponsors of the Center for American Progress. The Center is dedicated to promoting research to improve patient outcomes and improve patient care, as well as to promote understanding and support and innovation and innovation, resulting in better practices. It is also dedicated to building capacity from outside research institutions, encouraging the spread of innovation and to develop an effective policy environment (Regan, 1999).RAND has provided an effective policy framework for patients, clinicians, hospitals, and health care service providers, as well as the community, that is critical to enhancing the safety and well-being of a patient and providing timely and effective care during each visit (Mate, 2009). In some areas of medicine, RAND is associated with a strong emphasis on a broad range of outcomes than in others (Fried, 2005). However, as this model suggests, it is possible that RAND is missing key areas that are important, including family, community, and policy (Prentice et al., 2008 and Roper 2002). Because of high rates of complications, delays, and complications, RAND has become a significant source of funding (Klau et al., 2011). RAND’s findings on how to treat multiple sclerosis in patients benefit from a broad suite of interventions, as well as its success in increasing acceptance among patients (Larasen et al, 2003, 2014). In addition, RAND is a significant source of critical information regarding the treatment options available in the US, including the clinical evidence and outcomes (Nigault et al, 2013). Because of RAND’s role in the development of such data, it should be noted that RAND was co-financed by the University of Maryland School of Public Health, Johns Hopkins University, and the National Institutes of Health (Mantu et al, 1984). RAND was the recipient of the 2001 National Institute on Drug Abuse Developmental Grants (NIEDD); RAND’s Center for Research and Therapy (CRS) was formed in 1990, and CRS is based in Bethesda, MD and is based in the School of Public Health, Johns Hopkins University (Kau et al, 2011). RAND conducts its research without funding from any government or commercial sector. RAND’s activities and results should not be interpreted to indicate a commitment to any particular organization’s efforts or the direction of its activities (Mantu et al, 1984). RAND’s objectives, policy proposals, and data bases are set forth in NORML’s publication on Risk Management Practices and Management in Pediatric Medicine. RAND is available online with a PDF Download
RAND’s Clinical