Intense scrutiny of variations in practice and federal legislation that focuses on value are challenging traditional patterns of surgical care. Recognition that some patients receive treatments with little chance of clinical benefit while others fail to get necessary services has revealed a need to define, measure, and practice appropriate care.
While any use of low-value services increases spending unnecessarily, inappropriate or unnecessary care comprise nearly one-third of all wasteful spending in health care.1 Identifying appropriate care is a function of scientific evidence, expert opinion, patient values, and available resources. For example, the United Kingdom relies on guidance from the National Institute for Clinical Excellence to establish criteria for appropriate use,2 yet there is no such national body in the United States. The growing interest in appropriateness in this country motivated an expert panel discussion at the 12th Annual National Meeting of the Surgical Outcomes Club in Washington, DC. Whereas the concept and importance of appropriateness have been well described, panelists and the audience highlighted potential barriers to implementation and possible applications to surgical practice.
Weissman JS, Kelz RR, Lee CN. Appropriateness, Health Care Reform, and the SurgeonPerspectives From the Surgical Outcomes Club. JAMA Surg. Published online June 21, 2017. doi:10.1001/jamasurg.2017.1572