title: A scoping review of appropriateness of care research activity in Canada from a health system-level perspective.
abstract: BACKGROUND
  Jurisdictions are increasingly focusing on appropriate use of healthcare services and interventions as a means to improve health system performance. Our objectives were to conduct a scoping review to (a) map Canadian research and related activity on system-level appropriateness of care and (b) create a resource database that could be used to inform evidence-based decision-making and future research priorities in this area.
  
  
  METHODS
  We searched Medline, EMBASE and CINAHL databases between 2003-2013 using terms including "appropriate," "inappropriate," "health technology assessment" and "cost-effectiveness." Articles were included if they were Canadian-based and relevant to our definition. The database search was complemented by a website search of relevant Canadian organizations.
  
  
  RESULTS
  4,979 articles were identified through the literature search, and 103 articles relevant to system-level appropriateness of care across Canada were charted. Of these, 64 contained an evaluation of appropriateness, 30 used a method of cost-effectiveness or total cost impact analysis and 9 involved another methodology. The most common health service categories included drug therapy (n=40) and health service utilization (n=33). Fifty-eight websites were summarized containing material relevant to system-level appropriateness of care.
  
  
  CONCLUSIONS
  Our review identifies Canadian research and related activity pertaining to appropriateness of healthcare from a system-level perspective and provides a useful resource both to support evidence-based decision-making and to guide future appropriateness research.
authors: Health Council of Canada, Health System Performance, Health Quality Ontario Toronto, ON.
authors: Susan
authors: S
authors: Brien
authors: Health Council of Canada, Toronto, ON.
authors: Galina
authors: G
authors: Gheihman
authors: Health Council of Canada, Toronto, ON.
authors: Yi Ki Yvonne
authors: YK
authors: Tse
authors: Health Council of Canada Canadian Institute for Health Information, Toronto, ON.
authors: Mary
authors: M
authors: Byrnes
authors: Health Council of Canada, Toronto, ON.
authors: Sophia
authors: S
authors: Harrison
authors: Health Council of Canada Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON.
authors: Mark J
authors: MJ
authors: Dobrow
mesh_terms: D002170:Canada; D003695:Delivery of Health Care / Q000592:standards* / Q000706:statistics & numerical data; D006302:Health Services Research / Q000706:statistics & numerical data; D006801:Humans; D011787:Quality of Health Care / Q000592:standards; D019564:Unnecessary Procedures / Q000706:statistics & numerical data