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
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
AIESEC en Colombia. AIESEC en Colombia. Tu foto aquí _____ ACERCA DE MI. Por favor de manera detallada cuéntenos un poco acerca de usted, sus principales habilidades y su valor agregado para un emprendimiento o una ONG. _____
6,22 m2 y con una altura máxima de 7,5 metros cuesta $ 550 por unidad. Variaciones sobre el diseño puede permitir a largo plazo convertirse en hogares, clínicas de salud rurales, e incluso letrinas. Los albergues se han instalado en...
22 Full-Time Army and Air National Guardsmen whose only mission is to support civil authorities. Modular deployment packages. DoD's first response assets. All equipment meets NIOSH/ ANSI/OSHA Safety/Protection Standards. All members trained and certified to the HAZMAT Technician level (CFR...
stopwatch. is the time measured by the instrument under calibration. 2. isthecoverage factor k. ACCURACY. Frequency. Offset. DIRECT TIME MEASUREMENT. Author: Nubia Milena Rodriguez Roberto Title: Presentación de PowerPoint Last modified by:
One accommodation my CT and I made for the student was seating our student with vision impairment at the front of the room and provided with him with two desks to keep his stuff organized for academic purposes and for...
Computer Graphics Lecture 11 Texture Mapping ... Image is called a Texture map, it's pixels are often referred as a Texels and have coordinates (u,v) Texture coordinates are defined for each vertex of the polygon and interpolated across the polygon....
Ready to download the document? Go ahead and hit continue!