—Dr Bernstein is correct. To compare the appropriateness of coronary procedures in different countries and parts of a country, exactly the same methods must be used. Our methods were not the same as those used by the RAND researchers, and our estimation was based mainly on questionnaires sent to all patients on the waiting list for the various procedures. In addition, we checked the questionnaires against hospital records in a subset of patients. The major criterion for revascularization in Sweden is pain that is unacceptable to the patient despite optimal medical therapy.The published results in our study would be applicable and generalizable within Sweden, but the number of patients referred for these procedures varies markedly between regions. In southwestern Sweden, there is a fourfold difference in the number of procedures per million people between the regions with the highest and lowest number of revascularizations per million people.
Bengtson A. The Appropriateness of Coronary Procedures in Sweden-Reply. JAMA. 1994;272(16):1255. doi:10.1001/jama.1994.03520160038035