Appropriateness and necessity research of various procedures in medicine may be the most complex field of innovation in health care. Nevertheless, the appropriateness of the indication of any medical intervention is probably more important than the outcome since even ideal quality-components of structures, processes and outcomes become irrelevant without a proper indication.
The first part of our appropriateness initiative in interventional cardiology and gynaecology was to provide user friendly Internet access according to the basis of nationally recognised guidelines. The relevant information was provided by four national medical professional societies. To define the appropriateness for coronary angiography, coronary revascularisation and hysterectomy, literature based consensus methods were used. To present the results in a user-friendly way on the internet, we introduced a database schema as a conceptual model. The second part of the appropriateness initiative was to create a user-friendly internet-based data collection system.
For online results see:
http://sos.inf.ethz.chThe results demonstrate that research on indications with data on clinical outcome may open opportunities to validate indication-guidelines using internet/database technology for data analysis and browsing of decision graphs concerning clinical decision-making. This new technology facilitates the evaluation of appropriateness and necessity criteria in combination with clinical outcomes. Furthermore, the Swiss participation on multinational panels and the expert discussions at international workshops may have confirmed the Swiss position in this important research field.
