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Surgical Outcomes Club
September 2017

Appropriateness, Health Care Reform, and the SurgeonPerspectives From the Surgical Outcomes Club

Author Affiliations
  • 1Center for Surgery and Public Health, Department of Surgery, Harvard Medical School, Boston, Massachusetts
  • 2Center for Surgery and Health Economics, Department of Surgery, University of Pennsylvania, Philadelphia
  • 3Department of Plastic Surgery, College of Medicine, Ohio State University, Columbus
  • 4Division of Health Services Management and Policy, College of Public Health, Ohio State University, Columbus
JAMA Surg. 2017;152(9):813-814. doi:10.1001/jamasurg.2017.1572

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.