Sensitivity and specificity of the RAND/UCLA Appropriateness Method to identify the overuse and underuse of coronary revascularization and hysterectomy

There is no empirical evidence on the sensitivity and specificity of method s to identify the possible overuse and underuse of medical procedures. To e stimate the sensitivity and specificity of the RAND/UCLA Appropriateness Me thod. Parallel three-way replication of the RAND/UCLA Appropriateness Metho d for each of two procedures, coronary revascularization and hysterectomy. Maximum likelihood estimates of the sensitivity and specificity of the meth od for each procedure. These values were then used to re-calculate past est imates of overuse and underuse, correcting for the error rate in the approp riateness method. The sensitivity of detecting overuse of coronary revascul arization was 68% (95% confidence interval 60-76%) and the specificity was 99% (98-100%). The corresponding values for hysterectomy were 89% (85-94%) and 86% (83-89%). The sensitivity and specificity of detecting the underuse of coronary revascularization were 94% (92-95%) and 97% (96-98%), respecti vely. Past applications of the appropriateness method have overestimated th e prevalence of the over-use of hysterectomy, underestimated the prevalence of the overuse of the coronary revascularization. and provided true estima tes of the underuse of revascularization. The sensitivity and specificity o f the RAND/UCLA Appropriateness Method vary according to the procedure asse ssed and appear to estimate the underuse of procedures more accurately than their overuse. (C) 2001 Elsevier Science Inc. All rights reserved.