The concepts of appropriate and necessary care are fundamental to the creation of an efficient and equitable health-care delivery system. Evidence of inappropriate overuse and underuse of procedures has been documented even in health systems characterised by the absence of global budgets, capitation, utilisation review or the pressure of requiring a second opinion. Health systems should function in such a way that inappropriate care is progressively reduced, while appropriate and especially necessary care are maintained or increased. The ability to determine and identify which care is overused and which is underused is essential to this functioning. To this end, the "RAND/UCLA Appropriateness Method" (here given the acronym RAM) was developed by RAND and UCLA in the 198Os. It has been further developed and refined in North America and, increasingly, in Europe.
Health systems should function in such a way that the amount of inappropriate care is minimized, while at the same time stinting as little as possible on appropriate and necessary care. The ability to determine and identify which care is overused and which is underused is essential to this functioning. To this end, the "RAND/UCLA Appropriateness Method" was developed in the 1980s. It has been further developed and refined in North America and, increasingly, in Europe. The rationale behind the method is that randomized clinical trials--the "gold standard" for evidence-based medicine--are generally either not available or cannot provide evidence at a level of detail sufficient to apply to the wide range of patients seen in everyday clinical practice. Although robust scientific evidence about the benefits of many procedures is lacking, physicians must nonetheless make decisions every day about when to use them. Consequently, a method was developed that combined the best available scientific evidence with the collective judgment of experts to yield a statement regarding the appropriateness of performing a procedure at the level of patient-specific symptoms, medical history, and test results. This manual presents step-by-step guidelines for conceptualising, designing, and carrying out a study of the appropriateness of medical or surgical procedures (for either diagnosis or treatment) using the RAND/UCLA Appropriateness Method. The manual distills the experience of many researchers in North America and Europe and presents current (as of the year 2000) thinking on the subject. Although the manual is self-contained and complete, the authors do not recommend that those unfamiliar with the RAND/UCLA Appropriateness Method independently conduct an appropriateness study; instead, they suggest "seeing one" before "doing one." To this end, contact information is provided to assist potential users of the method.
This Handbook expertly instructs the reader on how to conduct applied health research across a number of disciplines. Particularly aimed at postgraduate health researchers and students of applied health research, it presents and explains a wide range of research designs and other contemporary issues in applied health research.
American healthcare is neither efficient nor available to all, and is also the most expensive in the world. This book argues that rationing of healthcare could work and proposes an approach to ration fairly, effectively and generously.
A practical resource book for school social workers and mental health professionals. This third edition will appeal to practicing professionals in schools and become a popular textbook for graduate level students enrolled in school social work and school counselling courses.
Written and edited by world-renowned experts in the field, Benzel's Spine Surgery: Techniques, Complication Avoidance and Management, 5th Edition, provides expert, step-by-step guidance on the evaluation and management of disorders of the spine. This definitive, two-volume work explores the full spectrum of techniques used in spine surgery, giving you the tools you need to hone your skills and increase your knowledge in this challenging area. Clearly organized and extensively revised throughout, it features contributions from both neurosurgeons and orthopaedic surgeons to present a truly comprehensive approach to spine disease. - Offers a thorough overview of the effective management of patients with spinal disorders, including fundamental principles, biomechanics, applied anatomy, instrumentation, pathophysiology of spinal disorders, surgical techniques, motion preservation strategies, non-surgical management, and complication avoidance and management, as well as controversies. - Focuses on both pathophysiology and surgical treatment of spine disease, with an increased emphasis on minimally invasive surgery. - Contains new features such as key points boxes at the beginning of chapters and algorithms to help streamline the decision making process. - Covers today's hot topics in spine surgery, such as health economics, artificial intelligence, predictive analytics, new less invasive techniques including endoscopic spine surgery, and the future of spine surgery. - Provides expert coverage of key topics including biomechanics of motion preservation techniques, spinal injuries in sports, biologics in spine fusion surgery, anterior sub-axial cervical fixation and fusion techniques, complex lumbosacropelvic fixation techniques, and many more. - Features more than 1,500 high-quality illustrations, as well as new procedural videos on en bloc spondylectomy, minimally invasive endoscopic posterior cervical foraminotomy, cervical total disc replacement, minimally invasive lumbar decompression of stenosis, and more. - Enhanced eBook version included with purchase. Your enhanced eBook allows you to access all of the text, figures, and references from the book on a variety of devices.
This book is the product of a unique collaboration by experts from leading international, regional and national agencies and professional organizations discussing on the current ‘hot’ issue on the judicious use and safety of radiation in radiology. There have been several cases involving radiation overexposure that have received international attention. Strategies and solutions to guide readers how to maximize the benefits and minimize the risks when using radiation in medicine are covered.
Developed in conjunction with the American Society of Colon and Rectal Surgeons, this comprehensive textbook provides readers with the full scope of surgical practice for patients with diseases of the colon and rectum. Expert surgeons, all active both as educators and with busy clinical practices, have written concise and practical chapters on the most commonly done procedures while providing much-needed insight on less frequently presentations, as well. The ASCRS Textbook is designed to meet the needs not only of colorectal specialists, but also the general surgeon in practice whose caseload includes patients with disorders and diseases of the colon, rectum and anus. Residents and fellows will also find a wealth of hands-on guidance and practical tips and tricks. The ASCRS Practice Parameters are incorporated in the book along with an appendix providing the most up-to-the minute access to best practice guidelines. Patient care and safety are addressed in each chapter. "[The ASCRS Textbook of Colon and Rectal Surgery] is a long awaited textbook for those in the field and it does not disappoint. It is brief and to the point, but does not lack the necessary detail expected from a society-produced publication. [It has an] easy-to-read quality that enhances comprehension for the trainee. It is by no means just a student textbook. The inclusion of "hot" current topics, like the anal fistula plug, makes it fresh and useful for experienced surgeons. This is an excellent addition to the colorectal library." (Doody's Review)
