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May 8, 1996

Users' Guides to the Medical LiteratureXI. How to Use an Article About a Clinical Utilization Review

Author Affiliations

Department of Internal Medicine, University of the Philippines, Manila; Department of Pediatrics, University of the Philippines, Manila; Department of Social and Preventive Medicine, University of Queensland, Herston, Queensland, Australia; Department of Family Practice, University of Michigan, Ann Arbor; Department of Medicine, McMaster University, Hamilton, Ontario; Department of Epidemiology and Biostatistics, School of Public Health, University of Sydney, Sydney, New South Wales, Australia; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario; Department of Laboratory Medicine, University of California at San Francisco.; fellow at the Institute for Health Policy Studies at the University of California at San Francisco; senior scientist at the Institute for Clinical Evaluative Sciences, University of Toronto (Ontario).
From the Institute for Clinical Evaluative Sciences in Ontario, University of Toronto (Ontario) Clinical Epidemiology and Health Care Research Program (Sunnybrook Unit), and the Departments of Medicine and Surgery, University of Toronto (Dr Naylor); and McMaster University Health Sciences Centre, Hamilton, Ontario (Dr Guyatt).

JAMA. 1996;275(18):1435-1439. doi:10.1001/jama.1996.03530420063038

CLINICAL SCENARIO  You are a general internist attending a medical advisory committee meeting as the newly appointed chief of staff in a large community hospital affiliated with a major health maintenance organization. A junior administrator presents data showing that the hospital's utilization of percutaneous transluminal coronary angioplasty (PTCA) is high relative to similar-sized centers with similar numbers of interventional cardiologists. He insinuates that unnecessary PTCAs are being done. The cardiologists present are infuriated, and the meeting degenerates into a shouting match. After the hospital chief executive officer brings the meeting back to order, you and the chief of cardiology agree to research the matter independently and report back in 1 week.

THE SEARCH  Raw utilization data are insufficient to assess whether cardiologists at your hospital are using PTCA inappropriately. You need to review their practice in light of criteria for deciding whether each application of PTCA was likely, given a