MEASURING THE NECESSITY OF MEDICAL PROCEDURES

This is a report on the extension of the concept of the appropriatenes s of a procedure to the necessity, or crucial importance, of that proc edure. To state that a procedure is crucial means that withholding the procedure would be deleterious to the patient's health. Appropriatene ss and necessity ratings for six procedures were obtained using a modi fied Delphi panel process developed in earlier work. Panels were compo sed of practicing clinicians who were recognized leaders in their fiel ds. The panels included both performers and nonperformers of the proce dure under discussion. For most procedures and panelists, necessity wa s related to appropriateness, but was distinct from it. The proportion of indications for which the procedure was crucial varied in clinical ly consistent ways both among and within procedures. However, panelist s did not achieve a consensus on necessity. Further research is sugges ted to refine the method to promote consensus and to validate further the ratings of necessity. In conclusion, necessity ratings can be used together with appropriateness ratings to address not only the overuse of procedures, but also to indicate limited access to care through un deruse of procedures.