title: The appropriateness of use of percutaneous transluminal coronary angioplasty in New York State.
abstract: OBJECTIVE
  To determine the appropriateness of use of percutaneous transluminal coronary angioplasty (PTCA) in New York State.
  
  
  METHODS
  Retrospective randomized medical record.
  
  
  METHODS
  Fifteen randomly selected hospitals in New York State that provide PTCA.
  
  
  METHODS
  Random sample of 1306 patients undergoing PTCA in New York State in 1990.
  
  
  METHODS
  Percentage of patients who underwent PTCA for indications rated appropriate, uncertain, and inappropriate.
  
  
  RESULTS
  The majority of patients received PTCA for chronic stable angina, unstable angina, and in the post-myocardial infarction period (up to 3 weeks). Fifty-eight percent of PTCAs were rated appropriate; 38%, uncertain; and 4%, inappropriate. The inappropriate rate varied by hospital from 1% to 9% (P = .12); the uncertain rate, from 26% to 50% (P = .02); and the combined inappropriate and uncertain rate, from 29% to 57% (P < .001). There was no difference in appropriateness when the institutions were grouped by volume (fewer than 300 procedures annually or at least 300 procedures annually), location (upstate vs downstate), or by teaching status.
  
  
  CONCLUSIONS
  Few PTCAs were performed for inappropriate indications in New York State. However, the large number of procedures performed for indications that were rated uncertain as to their net benefit requires further study and justification at both clinical and policy levels.
authors.affiliation: RAND, Santa Monica, CA 90406-2398.
authors.forename: L H
authors.initials: LH
authors.lastname: Hilborne
authors.forename: L L
authors.initials: LL
authors.lastname: Leape
authors.forename: S J
authors.initials: SJ
authors.lastname: Bernstein
authors.forename: R E
authors.initials: RE
authors.lastname: Park
authors.forename: M E
authors.initials: ME
authors.lastname: Fiske
authors.forename: C J
authors.initials: CJ
authors.lastname: Kamberg
authors.forename: C P
authors.initials: CP
authors.lastname: Roth
authors.forename: R H
authors.initials: RH
authors.lastname: Brook
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data*; D003625:Data Collection; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology; D012040:Regional Health Planning; D012189:Retrospective Studies; D016896:Treatment Outcome; D014600:Utilization Review / Q000706:statistics & numerical data*