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Criteria for the performance of coronary revascularization in Europe.
Title:
Development of standards of appropriate use of coronary revascularization in Europe.
Background:
There exists a high degree of variability in the use of coronary revascularization techniques. Available data suggest the possibility that a certain number of coronary revascularization procedures are carried out for inappropriate or questionable reasons. Ideally, these should only be performed in patients for whom it is deemed truly appropriate, with the aim of improving results and avoiding exposure to unnecessary risks.
Objectives:
To understand the extent of appropriate, inappropriate or questionable use of PTCAs and CRSs in 5 European countries (The Netherlands, United Kingdom, Switzerland, Italy and Spain), and explore possible explanatory variables of inappropriate use. This information could be used to selectively promote the appropriate procedures.
The specific objectives of the project are:
1) To produce a summary of current knowledge of PTCA and CRS via a critical review of the literature.
2) To define standards for the performance of PTCA and CRS by classifying the specific clinical circumstances in which the use thereof is appropriate, inappropriate or questionable.
3) To measure the proportion of appropriate, inappropriate and questionable use of PTCA and CRS in Spain, on a national level and by different subgroups, in accordance with the previously defined standards.
4) To determine the strnegth of the association of inappropriate use with a number of variables of the center and patient.
5) To identify areas relative to the PTCA and CRS where no information exists and where it is insufficient or contradictory, and might be the subject of research in the future.
Methodology:
To prepare a summary of the literature on PTCA and CRS and a list of indications for coronary revascularization. To create a group of experts, with 13 specialists in the five European countries. To define the standards of appropriate use.
To analyze the logical and clinical consistencies of the recommendations of appropriate use. To define the standards for necessary use. To analyze the maximum waiting time in terms of the patient's situation.
Participants, in addition to the Scientific Department of the Kovacs Foundation:
Research Unit of Health Care Services, of the Carlos III Institute of the Spanish Ministry of Health, RAND Europe, Swedish National Agency for Evaluation of Health Care Technology (SBU), University of Michigan in Ann Arbor (USA).
Financed by the BIOMED II project, from the XII General Management of the European Commission.
Status:
In progress. The tasks which have been completed have resulted in the following presentation given in the 1999 Conference of the International Society of Assessment of Health Care Technology:
Lázaro P, Fitch K, Aguilar MD, Bernstein S, Kahan J. The perceived evidence underlying the recommendations produced by experts. Proceedings of the International Society of Technology Assessment in Health Care (ISTAHC) 15th Annual Meeting. Edinburgh, UK, 20-23 June 1999.