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Appropriate and necessary.

In summary, we seem to be on our way to increasing our knowledge about what works and what does not. This information is desperately needed to help develop standards by which quality and appropriateness will be measured. However, enough information is currently available to allow hospitals and their medical staffs to develop standards, guidelines and parameters today in an effort to improve performance. The information produced from the application of the guidelines to actual practice can in turn be used to guide new effectiveness research into what works or does not. For instance, procedures that are frequently performed for equivocal reasons could become the focus of the effectiveness-research agenda. Meanwhile, methods research in both the effectiveness and appropriateness areas will continue so that more valid techniques in both of these areas can be developed. If cooperation between the people who generate new knowledge, the people who develop standards and the people who use the standards to improve institutional performance can be achieved, then we can improve the health of the American people at a price we will be willing to pay.