Appropriateness of healthcare interventions: concepts and scoping of the published literature.
OBJECTIVE
This report is a scoping review of the literature with the objective of identifying definitions, conceptual models and frameworks, as well as the methods and range of perspectives, for determining appropriateness in the context of healthcare delivery.


METHODS
To lay groundwork for future, intervention-specific research on appropriateness, this work was carried out as a scoping review of published literature since 1966. Two reviewers, with two screens using inclusion/exclusion criteria based on the objective, focused the research and articles chosen for review.


RESULTS
The first screen examined 2,829 abstracts/titles, with the second screen examining 124 full articles, leaving 37 articles deemed highly relevant for data extraction and interpretation. Appropriateness is defined largely in terms of net clinical benefit to the average patient and varies by service and setting. The most widely used method to assess appropriateness of healthcare services is the RAND/UCLA Model. There are many related concepts such as medical necessity and small-areas variation.


CONCLUSIONS
A broader approach to determining appropriateness for healthcare interventions is possible and would involve clinical, patient and societal perspectives.
Sanmartin
Claudia
C
Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada. Claudia.Sanmartin@statcan.ca
Murphy
Kellie
K
Choptain
Nicole
N
Conner-Spady
Barbara
B
McLaren
Lindsay
L
Bohm
Eric
E
Dunbar
Michael J
MJ
Sanmugasunderam
Suren
S
De Coster
Carolyn
C
McGurran
John
J
Lorenzetti
Diane L
DL
Noseworthy
Tom
T
D003695:Delivery of Health Care / Q000592:standards*; D006801:Humans; D008962:Models, Theoretical; D009626:Terminology as Topic