Appropriate use criteria

Appropriate use criteria (AUC), sometimes referred to as appropriateness criteria (AC), specify when it is appropriate to perform a medical procedure or service. An “appropriate” procedure is one for which the expected health benefits exceed the expected health risks by a wide margin. Ideally, AUC are evidence-based, but in the absence of sufficient evidence, may be derived from a consensus of expert opinion. AUC are typically classified in terms of the quality of the evidence on which they are based. In general, AUC are promulgated by medical specialty organizations (professional societies).[citation needed] The definition of “appropriate” is subject to interpretation. For example, a key issue is whether or not a procedure or investigation can be deemed appropriate if it does not result in a change in management.[1]

The examples and perspective in this article deal primarily with the United States and do not represent a worldwide view of the subject. (December 2014)

Relative costs of alternative appropriate procedures may or may not be considered in selecting a procedure for an individual patient, but in there is evidence that performing only appropriate procedures reduces volume[2] and cost.[3] To reduce the cost of (advanced) diagnostic imaging tests, a requirement for the use of clinical decision support for was included in the Protecting Access to Medicare Act of 2014, though it does not apply to emergency or inpatient services.

AUC are not always consistent between sources, or with other guidelines, or with reimbursement decisions.[4][5] Additionally, AUC have not shown an impact in physician’s behaviour.[6] AUC may be promulgated in human-readable form, or converted into an electronic structured form for use in a clinical decision support system, such as a computerized physician order entry system.

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  1. Armstrong W; Eagle K. A. (23 September 2013). “Appropriate Use Criteria in Cchocardiography: Is No Change the Same as No Benefit?”. JAMA Internal Medicine. 173 (17): 1609–1610. doi:10.1001/jamainternmed.2013.7273. ISSN 2168-6106. PMID 23877483.
  2. Blackmore, C. Craig; Robert S. Mecklenburg; Gary S. Kaplan (January 2011). “Effectiveness of Clinical Decision Support in Controlling Inappropriate Imaging”. Journal of the American College of Radiology. 8 (1): 19–25. doi:10.1016/j.jacr.2010.07.009. PMID 21211760.
  3. Puri, Pranav; Bobette Patterson; Jennifer Carrol; Darshan Hullon; Sanjeev Puri (12 March 2013). “The Economic Impact of Implementation of Appropriate Use Criteria on Volume of PCI Cases and Medical Cost Savings at a Large Community Hospital”. Journal of the American College of Cardiology. 61 (10_S): E1499. doi:10.1016/S0735-1097(13)61499-0. ISSN 0735-1097.
  4. Fonseca, R.; Negishi, K.; Marwick, T. H. (1 August 2015). “What Is the Evidence Status of Appropriate Use Criteria (AUC)? Insight from a Matching Exercise with the Guidelines for Echocardiography”. Internal Medicine Journal. 45 (8): 864–869. doi:10.1111/imj.12829. ISSN 1445-5994. PMID 26220028.
  5. Fogel, Richard I.; Andrew E. Epstein; N. A. Mark Estes III; Bruce D. Lindsay; John P. DiMarco; Mark S. Kremers; Suraj Kapa; Ralph G. Brindis; Andrea M. Russo (7 January 2014). “The Disconnect Between the Guidelines, the Appropriate Use Criteria, and Reimbursement Coverage Decisions: The Ultimate Dilemma”. Journal of the American College of Cardiology. 63 (1): 12–14. doi:10.1016/j.jacc.2013.07.016. ISSN 0735-1097. PMID 23916934.
  6. Fonseca, R.; Negishi, K.; Otahal, P.; Marwick, T. H. (2015). “Temporal Changes in Appropriateness of Cardiac Imaging”. Journal of the American College of Cardiology. 65 (8): 763–73. doi:10.1016/j.jacc.2014.11.057. ISSN 0735-1097. PMID 25720619.

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