title: [The impact of social and institutional characteristics on the appropriateness of invasive cardiologic procedures].
abstract: OBJECTIVE
  Germany has the highest per capita rate of invasive cardiologic procedures in Europe. An aim of the SULEIKA study was to present a clearer picture of this important area of health care.
  
  
  METHODS
  Clinical data along with social characteristics of patients were acquired by means of questionnaires. An additional survey was established to collect data about the treating institution. Clinical information was used to define the appropriateness of coronary angiographies and percutaneous coronary interventions. A possible impact of social or institutional characteristics on the appropriateness was examined.
  
  
  RESULTS
  549 of 709 diagnostic coronary angiographies (77.4%) were rated "appropriate", 54 (7.6%) as "equivocal", and 106 (15%) as "inappropriate". 245 of 317 coronary interventions (77.3%) were rated "appropriate", 40 (12.6%) as "equivocal", and 32 (10.1%) as "inappropriate". Social and institutional impact were found for invasive diagnostics but not for PCI.
  
  
  CONCLUSIONS
  Social characteristics of patients and institutional characteristics have only a marginal impact on the indication of invasive cardiologic procedures. A trend toward "overdiagnostics" within the group of younger patients has been noticed, even in the case of missing hard medical evidence. A serious deficit of health care research can be found. Consented criteria to assess the appropriateness of medical treatments are missing. More research has to be done in the field of concepts and processes controlling the distribution and movement of patients into different sections of the health care system. Validated, standardized and comprehensive data for an international comparison of decisions about medical treatments are needed.
authors.affiliation: AG 1 Sozialepidemiologie und Gesundheitssystemgestaltung, Fakultät für Gesundheitswissenschaften, Universität Bielefeld, Bielefeld. michaela.brausse@uni-bielefeld.de
authors.forename: Michaela
authors.initials: M
authors.lastname: Brause
authors.forename: Gesine
authors.initials: G
authors.lastname: Grande
authors.forename: Hermann
authors.initials: H
authors.lastname: Mannebach
authors.forename: Bernhard
authors.initials: B
authors.lastname: Badura
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data*; D006328:Cardiac Catheterization / Q000706:statistics & numerical data*; D017023:Coronary Angiography / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005260:Female; D005858:Germany; D006300:Health Services Misuse / Q000706:statistics & numerical data; D006306:Health Surveys; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000706:statistics & numerical data*; D011785:Quality Assurance, Health Care / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014600:Utilization Review / Q000706:statistics & numerical data