What's Good About Appropriate Use Criteria?

What's Good About Appropriate Use Criteria?

Whats Good About Appropriate Use Criteria? Larry S. Dean, MD Professor of Medicine and Surgery University of Washington School of Medicine Seattle, WA No Conflicts to Disclose Lecture Outline

What is the purpose of AUCs? How should they be applied? Limitations Guidelines, Measures, and Appropriate Use Criteria Clinical Guidelines1

Performance Measures2

Exhaustive review of literature Virtually all-inclusive Best practice Should do, should not do Selective, focused, measurable

Based on guidelines Must do Tools for quality measurement Appropriate Use Criteria3

Selective indications Largely guideline based Clinical scenarios Reasonable to do 1. Klocke FJ, Baird MG, Lorell BH, et al. ACC/AHA/ASNC guidelines for the clinical use of cardiac radionuclide imaging. Circulation 2003; 106: 1883-92 2. Krumholtz HM, Anderson JL, Brooks, et al.

ACC/AHA clinical performance measures for adults with ST-elevation and non-ST-elevation myocardial infarction. J Am Coll Cardiol 2006; 47: 236-65. 3. Brindis RG, Douglas PS, Hendel RC et al. ACCF/ASNC appropriateness criteria for singlephoton emission computed tomography myocardial perfusion imaging. J Am Coll Cardiol 2005; 46: 1587-605. Technical Panel

The technical panel is created from nominations given by multiple relevant professional societies and provider-led organizations as well as from health policy and payer communities. To preserve objectivity, technical panels are created so as to not include a majority of individuals whose livelihood is tied to the technology under evaluation

What is the Purpose of AUCs? Appropriateness criteria are designed to examine the use of diagnostic and therapeutic procedures to support efficient use of medical resources during the pursuit of quality medical care Whats Good About AUCs Consistent with existing guidelines and performance measures

Focus on diagnostic and therapeutic procedures Applicable to different care environments Account for patient/family values, preferences, goals Consider co-morbidities Benefit versus risk Simple,reliable, and valid Transparent

Appropriate Use of Cardiovascular Procedures Potential Positive Impact of Appropriate Use Criteria Establishment of partnership among clinicians, and payers regarding rational practices and fair reimbursement for advanced imaging Education of clinicians regarding their practice habits Emphasis of clinical indications to drive testing Facilitate reimbursement for appropriate and

maybe appropriate indications Support for review and reduction of rarely appropriate indications Help bend the cost curve AUCs: How Should They be Applied? Appropriateness of Cardiovascular Procedures Ranking of Indications

7-9: Appropriate (A) test for specific indication Test is generally acceptable and is a reasonable approach for the indication 4-6: Maybe Appropriate (M) or unclear if appropriate for specific indication Test may be generally acceptable and may be a reasonable approach for the indication 1-3: Rarely Appropriate (R) test for specific indication

Test is not generally acceptable and is not a reasonable approach for the indication 2012 AUC: Focused Update: New or Revised Indications Patel MR, et al. J. Am. Coll. Cardiol. 2012;59;857-881 2012 AUC: Focused Update

Patel MR, et al. J. Am. Coll. Cardiol. 2012;59;857-881 2012 AUC: Focused Update Patel MR, et al. J. Am. Coll. Cardiol. 2012;59;857-881 2012 AUC Focused Update: Method of Revascularization

Patel MR, et al. J. Am. Coll. Cardiol. 2012;59;857-881 Application of AUCs Excellent for ongoing review of ones practice using the criteria will help guide a more effective, efficient, and equitable allocation of healthcare resources, and ultimately, better patient outcomes and In situations where there is substantial variation between the appropriateness rating and what the

clinician believes is the best approach for a specific patient, further considerations may be appropriate. Limitations of AUCs Limitations of AUCs Appropriate use criteria are intended to assist patients and clinicians, but are not intended to diminish the acknowledged difficulty or uncertainty of clinical decision making and

cannot act as substitutes for sound clinical judgment and practice experience They identify common clinical scenariosbut they cannot possibly include every conceivable patient presentation. SCAI AUC App scai-qit.org

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