CRITERIA FOR PERFORMING CORONARY
REVASCULARIZATION IN EUROPE
Title.
Development of standards for appropriate
use of coronary revascularization in Europe.
Background.
There is wide variability in the use of techniques
of coronary revascularization such as percutaneous transluminal
coronary angioplasty (PTCA) and coronary revascularization
surgery (CRS). The available data suggest the possibility
that some proportion of the coronary revascularization procedures
is made for inappropriate or uncertain reasons. The ideal
situation would be to perform them only on patients in whom
it is truly appropriate, in order to improve the outcomes
and to avoid exposure to unnecessary risks.
Objectives.
To know the degree of appropriate, inappropriate
and uncertain use of the PTCA's and CRS's in 5 European countries
(Holland, United Kingdom, Switzerland, Italy and Spain) and
to explore possible explanatory variables for their inappropriate
use. This information could be used to promote selectively
the appropriate procedures.
To that end, the specific objectives of the project are:
To produce a synthesis of current
knowledge about PTCA and CRS by means of a critical review
of the literature.
To establish standards for carrying
out PTCA and CRS, classifying the specific clinical circumstances
in which their use is appropriate, inappropriate and uncertain.
To measure the proportion of appropriate,
inappropriate and uncertain use of PTCA and CRS in Spain
on a national level and by different subgroups, according
to the previously established standards.
To determine the strength of association
of the inappropriate use with a series of variables involving
the center and the patient.
To identify the areas relative
to PTCA and CRS in which there is no information or where
the information is insufficient or contradictory, which
should be researched in the future.
Methodology.
To prepare a synthesis of the literature
on PTCA and CRS and the list of indications for coronary revascularization.
To constitute a group of experts with 13 specialists from
five European countries. To establish the standards for appropriate
use. To analyze the logical consistency and the clinical consistency
of the recommendations for appropriate use. To elaborate the
standards for necessary use. To analyze the maximum waiting
time according to the patient's situation.
Participants, along with the Foundation's
Science Department.
Unit of Research in Health Services at the
Carlos III Institute of the Spanish Ministry of Health and
Consumer Protection, RAND Europe, Swedish National Agency
for the Evaluation of Health Technology, University of Michigan
in Ann Arbor (USA).
Funded by the BIOMED II project of the General Directorate
of Research of the European Commission.
Status.
The tasks carried out have given rise to
the following publications:
Med Care 2001 May; 39(5): 513-20.
Eur J Cardiothorac Surg 2000 Oct; 18(4): 380-7
Eurohealth, 1999; vol5, num 3:19-21.
Additionally, the following papers have been presented:
16th Annual Meeting of the International Society of Technology
Assessment in Health Care. La Haya, Holanda, 18-21//06/2000.
Proceedings of the International Society of Technology
Assessment in Health Care (ISTAHC) 15th Annual Meeting.
Edinburgh, UK, 20-23 June 1999.
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