Users' guides to the medical literature. XI. How to use an article about a clinical utilization review. Evidence-Based Medicine Working Group.

CLINICAL SCENARIO You are a general internist attending a medical advisory committee meeting as the newly appointed chief of staff in a large community hospital affiliated with a major health maintenance organization. A junior administrator presents data showing that the hospital's utilization of percutaneous transluminal coronary angioplasty (PTCA) is high relative to similar-sized centers with similar numbers of interventional cardiologists. He insinuates that unnecessary PTCAs are being done. The cardiologists present are infuriated, and the meeting degenerates into a shouting match. After the hospital chief executive officer brings the meeting back to order, you and the chief of cardiology agree to research the matter independently and report back in 1 week. THE SEARCH Raw utilization data are insufficient to assess whether cardiologists at your hospital are using PTCA inappropriately. You need to review their practice in light of criteria for deciding whether each application of PTCA was likely, given a