{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T00:45:28Z","timestamp":1777682728274,"version":"3.51.4"},"reference-count":38,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2020,9,10]],"date-time":"2020-09-10T00:00:00Z","timestamp":1599696000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"Kinetika Sardinia"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Health Serv Manage Res"],"published-print":{"date-parts":[[2021,8]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Appropriateness is an essential element of quality of care. Several methods and tools have been developed to measure the appropriateness of care, however, none of these could be used to systematically support providers in keeping the appropriateness under control. Our study aimed to develop a framework to evaluate the appropriateness of care that took into account four dimensions of appropriateness: clinical dimension, equity, service delivery model, outcome.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We employed mixed-method approaches. These included a retrospective analysis of administrative data collected from Kinetika Sardinia (Italy) and a qualitative analysis of stakeholders\u2019 experiences and perspectives aimed at supporting data collection, identification of improvement actions and definition of performance indicators. We used arthrodesis as a paradigmatic example of potentially inappropriate elective surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We collected data from 2,584 patients that underwent arthrodesis between January 1, 2010 and April 30, 2015. Based on the analysis and the exchanges with professionals, we identified 11 improvement actions. Monitoring and evaluation actions were finally conducted for 171 patients that underwent spinal fusion during the first semester of 2016 in order to assess if the improvement actions identified were put into practice and acquired desirable outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Our work provides a definition of appropriateness that goes beyond the clinical perspective and includes other perspectives (equity, service delivery and outcome); develops a framework and an approach that can be a valid help to systematically assess the appropriateness of elective surgery, adopt improvement actions, and monitor their impact; discusses what are the competencies necessary for measuring the appropriateness.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/0951484820952331","type":"journal-article","created":{"date-parts":[[2020,9,10]],"date-time":"2020-09-10T12:42:46Z","timestamp":1599741766000},"page":"167-177","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Evaluating the appropriateness of elective surgery: The case of spinal fusion (arthrodesis)"],"prefix":"10.1177","volume":"34","author":[{"given":"Valeria D","family":"Tozzi","sequence":"first","affiliation":[{"name":"Centre for Research on Health and Social Care, Bocconi University, Italy; SDA Bocconi, School of Management, Government Health and Not for profit Division, Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guglielmo","family":"Pacileo","sequence":"additional","affiliation":[{"name":"Centre for Research on Health and Social Care, Bocconi University, Italy; SDA Bocconi, School of Management, Government Health and Not for profit Division, Milan, Italy"},{"name":"Local Health Authority Alessandria, Milano, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6955-8983","authenticated-orcid":false,"given":"Lucia","family":"Ferrara","sequence":"additional","affiliation":[{"name":"Centre for Research on Health and Social Care, Bocconi University, Italy; SDA Bocconi, School of Management, Government Health and Not for profit Division, Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2020,9,10]]},"reference":[{"key":"bibr1-0951484820952331","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.309.6956.730"},{"key":"bibr2-0951484820952331","doi-asserted-by":"publisher","DOI":"10.1093\/intqhc\/15.1.15"},{"key":"bibr3-0951484820952331","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-138-4-200302180-00006"},{"key":"bibr4-0951484820952331","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1988.03410040077031"},{"key":"bibr5-0951484820952331","first-page":"JE01","volume":"10","author":"Tayade MC","year":"2016","journal-title":"J Clin Diagn Res"},{"key":"bibr6-0951484820952331","first-page":"351","volume":"24","author":"Leape LL.","year":"1989","journal-title":"Health Serv Res"},{"key":"bibr7-0951484820952331","doi-asserted-by":"publisher","DOI":"10.1146\/annurev.pu.13.050192.002051"},{"key":"bibr8-0951484820952331","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198211183072104"},{"key":"bibr9-0951484820952331","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(06)69616-5"},{"key":"bibr10-0951484820952331","doi-asserted-by":"publisher","DOI":"10.1093\/intqhc\/mzl024"},{"key":"bibr11-0951484820952331","volume-title":"Improving healthcare quality in Europe: characteristics, effectiveness and implementation of different strategies","author":"Busse R","year":"2019"},{"key":"bibr12-0951484820952331","volume-title":"The RAND\/UCLA appropriateness method user\u2019s manual","author":"Fitch K"},{"key":"bibr13-0951484820952331","doi-asserted-by":"publisher","DOI":"10.5694\/mja12.10510"},{"key":"bibr14-0951484820952331","doi-asserted-by":"publisher","DOI":"10.1017\/S0266462308080458"},{"key":"bibr15-0951484820952331","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.166.2.220"},{"key":"bibr16-0951484820952331","author":"Robertson-Preidler J","journal-title":"BMC Health Serv Res"},{"key":"bibr17-0951484820952331","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.312.7023.71"},{"key":"bibr18-0951484820952331","doi-asserted-by":"publisher","DOI":"10.1093\/heapol\/14.4.409"},{"key":"bibr19-0951484820952331","doi-asserted-by":"publisher","DOI":"10.1016\/0168-8510(95)00787-3"},{"key":"bibr20-0951484820952331","doi-asserted-by":"publisher","DOI":"10.1016\/0168-8510(96)00817-2"},{"key":"bibr21-0951484820952331","doi-asserted-by":"publisher","DOI":"10.1093\/intqhc\/6.3.251"},{"key":"bibr22-0951484820952331","doi-asserted-by":"publisher","DOI":"10.1053\/j.sult.2005.02.007"},{"key":"bibr23-0951484820952331","doi-asserted-by":"publisher","DOI":"10.3171\/2014.4.SPINE14270"},{"key":"bibr24-0951484820952331","doi-asserted-by":"publisher","DOI":"10.1097\/01.brs.0000248132.15231.fe"},{"key":"bibr25-0951484820952331","doi-asserted-by":"publisher","DOI":"10.1111\/imj.14120"},{"key":"bibr26-0951484820952331","doi-asserted-by":"publisher","DOI":"10.4055\/cios.2011.3.1.39"},{"key":"bibr27-0951484820952331","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-014-3284-0"},{"key":"bibr28-0951484820952331","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2015-009011"},{"key":"bibr29-0951484820952331","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2010.338"},{"key":"bibr30-0951484820952331","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0b013e31820cccfb"},{"key":"bibr31-0951484820952331","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1987.03400180067028"},{"key":"bibr32-0951484820952331","unstructured":"Buzzi N, Cananzi G, Conti S, et\u00a0al.\n                      ERA \u2013 Ospedalizzazione evitabile per genere e unit\u00e0 sanitaria territoriale - Ed. 2009\n                      .\n                      Natalia Buzzi\n                      , 2009."},{"key":"bibr33-0951484820952331","volume-title":"The RAND\/UCLA appropriateness method","author":"Brook RH.","year":"1995"},{"key":"bibr34-0951484820952331","first-page":"1","volume":"74","author":"Cleary PD.","year":"1996","journal-title":"Milbank Q"},{"key":"bibr35-0951484820952331","unstructured":"ISASS. 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