0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
ARTICLE |

Relationship of Anatomic Disease to Appropriateness Ratings of Coronary Angiography

Susan J. Noonan, MD, MPH; Jan L. Cook, MD, MPH; Candace E. Keller, MD, MPH; Carla M. Rosenkrans, RN, BSN; Joseph M. Healy Jr, PhD; Lisa Feingold, MSPH; Stephen C. Schoenbaum, MD, MPH
Arch Intern Med. 1995;155(11):1209-1213. doi:10.1001/archinte.1995.00430110129014.
Text Size: A A A
Published online

Background:  At Harvard Community Health Plan (HCHP), Brookline, Mass, a mixed-model health maintenance organization (HMO), coronary angiography is performed at numerous community and tertiary-level teaching hospitals.

Objective:  To determine the appropriateness of coronary angiography within HCHP according to RAND (1992) criteria and to examine the relationship between the appropriateness rating and (1) the clinical indication for catheterization and (2) the extent of anatomic disease.

Method:  A retrospective, randomized hospital medical record review of 292 patients enrolled in HCHP who underwent coronary angiography in 1992, stratified by four distinct HCHP subgroups.

Results:  Of the coronary angiographies reviewed, 78% were rated appropriate, 16% uncertain, and only 6% inappropriate across the entire sample. Ratings were comparable in all subdivisions of HCHP despite an incidence rate of catheterization in one of the three HMO divisions that was 60% and 40% higher than in the other two divisions. The lowest appropriateness ratings were for Asymptomatic patients (43%) and those with Chest Pain of Uncertain Origin (35%) (capital letters refer to the RAND clinical indication criteria mentioned above). A rating of necessity was not a better discriminator of anatomic disease than a rating of appropriateness alone: 82% and 84%, respectively, were found to have disease by angiography.

Conclusion:  The low HCHP rate of inappropriateness for coronary angiography is comparable with the RAND 1992 New York State data. This finding, coupled with marked differences in the incidence rate of this procedure among the HCHP divisions, is consistent with either major differences in the sickness of the HMO's subpopulations or, more likely, a lack of specificity of the RAND criteria for coronary angiography.(Arch Intern Med. 1995;155:1209-1213)

Topics

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Figures

Tables

References

Correspondence

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Web of Science® Times Cited: 10

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Related Content

Customize your page view by dragging & repositioning the boxes below.

Jobs
brightcove.createExperiences();