ACC updates AUC methodology

The process for developing appropriate use criteria, including adjustments to frequently misinterpreted terminology for describing levels of appropriate care, has been updated by the American College of Cardiology.

“The new terminology and definitions more accurately reflect how appropriate use criteria should be used for quality improvement and clinically, including consideration for physician judgment, measurement of patterns of use over time and the potential hazard of applying inflexible rules to individual patient situations,” Robert C. Hendel, MD, FACC, chair of the appropriate use criteria (AUC) writing committee, said in a press release. “The new terminology will be applied in development of all subsequent appropriate use criteria. The first document using the new terms is slated for release later this month, focusing on implantable cardiac defibrillators and cardiac resynchronization.”

Updated methodology

The AUC development process was established in 2005, based on the RAND Appropriateness Method, which was developed to determine when and how often medical procedures should be performed. The new paper serves as an update, according to the press release.

The update includes categories of appropriateness and are “meant to reflect a continuum of benefits and risks to various patient populations,” the authors wrote in the report published in the Journal of the American College of Cardiology.

According to the release, under the updated methodology, appropriateness of procedures or use of imaging for specific populations will be described as:

Appropriate: An appropriate option for managing patients includes situations when the benefits generally outweigh risks; an effective option for individual care plans, although not always necessary, depending on physician judgment and patient-specific preferences.
May be appropriate: At times an appropriate option for managing patients due to variable evidence or agreement regarding the benefit/risk ratio, potential benefit based on practice experience in the absence of evidence and/or variability in the population; effectiveness for individual care must be determined by a patient’s physician in consultation with the patient based on additional clinical variables and judgment along with patient preferences.
Rarely appropriate: Rarely an appropriate option for managing patients due to lack of a clear benefit/risk advantage; rarely an effective option for individual care plans; exceptions should have documentation of the clinical reasons for proceeding with this care option.

Additional guidance

Other changes in the report include the introduction of a formal review process prior to rating, administration of a survey of professional expertise for rating panel balance and establishment of a relationship-with-industry policy.

“[T]he appropriate use criteria intent is as a guiding document; the final decision to proceed with testing or a procedure remains at the bedside where patient-physician interaction simply cannot be universally policy-based and must be done in the context of a discussion about treatment and patient goals, which is never a black and white decision,” the authors wrote.

For more information:

Hendel RC. J Am Coll Cardiol. 2013;doi:10.1016/j.jacc.2013.01.025.

Disclosure: Hendel reports no relevant financial disclosures.