APPROPRIATENESS IN PATIENT-CARE - A NEW CONCEPTUAL-FRAMEWORK

In recent years the focus for the evaluation of health services has sh ifted from unnecessary treatment-specifically, unnecessary surgery-to appropriateness research. This new emphasis constitutes a shift in the burden of proof, indicating increased attention to the evidentiary ba sis of medical and surgical practice. The evaluation of the appropriat eness of health services is also seen as integral to the reforming dri ve to contain health care costs and improve quality. Because of its pi votal role as a criterion in health care decision-making, the concept of appropriateness requires clarification. Three sources of value are defined that give meaning to ''appropriateness'' in patient care: the clinical point of view, the point of view of the individual patient, a nd the societal point of view. This framework is also used to shed lig ht on the issue of medical futility.