a1 University of Calgary and Statistics Canada
a2 Statistics Canada
a3 University of Regina
a4 University of Calgary
a5 University of Manitoba and Concordia Hospital
a6 Dalhousie University and QE II Health Sciences Centre
a7 University of British Columbia
a8 University of Calgary and Calgary Health Region
a9 University of Toronto
a10 University of Calgary and Institute of Health Economics
a11 University of Calgary
Objectives: 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.
This work was funded by Health Canada.