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“Quality,” “safety,” “value,” “cost,” “measurement,” “alignment,” “performance,” “incentives,” “triple aim.” These words and phrases, among others, are now part of the standard lexicon of contemporary health care delivery in the United States. Clinical and scientific journals have published many articles studying and discussing these topics, and the popular press has described the notion of “overkill” in referring to unnecessary medical care.1 A key word in all of these discussions is “appropriate.” According to Hendel et al, “an appropriate diagnostic or therapeutic procedure is one in which the expected clinical benefit exceeds the risks of the procedure by a sufficiently wide margin such that the procedure is generally considered acceptable or reasonable care.”2 Are health care professionals recommending, ordering, or performing diagnostic tests or therapeutic interventions supported by high-quality evidence? Or, as noted in this definition, are they ordering tests and performing interventions more likely to be helpful than harmful?
Harrington RA. Appropriate Use Criteria for Coronary Revascularization and the Learning Health SystemA Good Start. JAMA. 2015;314(19):2029-2031. doi:10.1001/jama.2015.15436