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AUCs in Development

The AAOS is currently working on the following three Appropriate Use Criteria (AUC):

Three panels—writing, review, and voting—are involved in preparing AUCs. The AAOS follows the RAND/UCLA appropriateness method procedures and all AUCs are based on a systematic review of the research literature.

AUC on DRF
The writing, review, and voting panels for the DRF AUC have completed their work and this first AUC is expected to be presented to the AAOS Board of Directors for final approval during its March meeting. The writing panel included physicians from the AAOS Board of Councilors (BOC), the American Society for Surgery of the Hand, Orthopaedic Trauma Association, and American Association for Hand Surgery. The DRF AUC is based on an AAOS clinical practice guideline (CPG) plus an updated literature review. A web-based dissemination application is also being developed; it will be pilot tested with the release of the DRF AUC.

Advancing Quality with Appropriate Use Criteria

Jayson Murray

For the past two decades, numerous medical organizations have used appropriate use criteria (AUC) to provide clinicians and patients with a measurement of overuse and underuse of medical and surgical procedures. Among the organizations that have developed AUC are the American College of Cardiology, the American College of Radiology, the North American Spine Society, the American Society of Nuclear Cardiology, and the American Academy of Dermatology. The AAOS began developing AUC in 2011.

AUC are an important addition to a physician’s clinical resources. Adherence to evidence-based medicine (ie, clinical practice guidelines, or CPGs) affords clinicians a powerful tool to aid them, along with their expertise and experience, when making day-to-day clinical decisions. Unfortunately, randomized clinical trials—the “gold standard” for evidence-based medicine—are often not available or cannot apply to the wide range of patients seen in everyday practice. If gaps in the literature exist, AUC can be thought of as the mortar that fills these gaps, using the expertise and experience of clinicians who are specialists in the topic of interest.

AUC Update: Rotator Cuff Management

The 16 members of the Management of Full-Thickness Rotator Cuff Tears Appropriate Use Criteria (AUC) voting panel met in Rosemont on June 1, 2013, to discuss their first round of appropriateness ratings. Panel members include physical therapists, rheumatologists, and orthopaedic surgeons. (See the online version of this article, available at www.aaosnow.org, for a complete list of participants.) Appropriateness ratings for hundreds of patient scenarios were discussed with specific attention to those that resulted in polarization among the panel members.

The voting panel is now on the second round of voting, and the results are being aggregated by AAOS staff for the final document. This AUC is expected to be released later this year.

This is the second AUC to be developed; the first—Treatment of Distal Radius Fractures—can be accessed at www.aaos.org/aucapp

Capitalizing on Research Expertise

AAOS extends a helping hand to other associations

Jayson Murray, MA, and Ryan Pezold, MA

Developing clinical practice guidelines (CPGs) and appropriate use criteria (AUC) isn’t easy. And when it comes to these and other evidence-based medicine (EBM) tools, few professional medical organizations can match the AAOS in experience, expertise, and proprietary technology.

AAOS Adopts Position Statement on Imaging AUC

At its meeting on Sept. 21, 2013, the Board of Directors of the American Association of Orthopaedic Surgeons (AAOS) adopted a new statement of principles on appropriate use criteria (AUC) for orthopaedic imaging services. The AAOS supports the use of AUC and is in the process of incorporating imaging in both clinical practice guidelines and AUC.

Recent efforts to close the in-office ancillary services (IOAS) exception have focused on the perceived overutilization of these services, including imaging services. This statement will provide a guideline for the AAOS to effectively evaluating any legislative proposal that attempts to address the IOAS issue through the use of AUC on orthopaedic imaging services. The complete text of the position statement follows.

Principles on AUC for Orthopaedic Imaging Services
The American Association of Orthopaedic Surgeons (AAOS) is committed to the highest quality of care for patients undergoing musculoskeletal procedures. Appropriate Use Criteria (AUC) is an important step in ensuring the best use of healthcare resources and preventing unnecessary treatments. The AUC specifies when it is appropriate to use a procedure. An “appropriate procedure” is one for which the expected health benefits exceed the expected health risks by a wide margin. AUCs combine the best available scientific evidence with the collective judgment of physicians in order to determine the appropriateness of performing a procedure.

What Are Appropriate Use Criteria?

The next step on the road to quality

Mary Ann Porucznik

According to Kristy L. Weber, MD, past chair of the AAOS Council on Research and Quality, “Appropriate Use Criteria (AUC) specify when it’s appropriate to perform a procedure or service.” An “appropriate” procedure is one for which the expected health benefits exceed the expected health risks by a wide margin.

New AUCs and CPGs on the Way

CPGs/systematic literature review
Management of Osteoarthritis of the Hip CPG
This guideline is currently in the public comment stage and is expected to be released in early 2017. The work group includes clinicians representing the AAOS, American Association of Hip and Knee Surgeons (AAHKS), American College of Radiology, American Physical Therapy Association (APTA), The Hip Society, Limb Lengthening and Reconstruction Society, and the Pediatric Orthopaedic Society of North America (POSNA).

New AUC Cover Hip Fracture in the Elderly and Osteochondritis Dissecans

The Academy's roster of Appropriate Use Criteria  (AUC) has grown by three, with the addition of two online applications covering  management of hip fractures in the elderly (acute treatment and postoperative  rehabilitation of low-energy hip fractures) and one for treatment of pediatric  patients with osteochondritis dissecans (OCD) of the femoral condyle. The AUC  were approved at the December 2015 meeting of the AAOS Board of Directors.

Get Involved in the AUC Process

Appropriate use criteria are the next step in quality improvement

Jayson N. Murray

Every day, orthopaedic surgeons and their patients are faced with making decisions about treatment options that, unfortunately, often don’t have strong evidential support. In addition, what might be considered appropriate care for a 35-year-old generally healthy patient might not be appropriate for a 70-year-old patient with multiple comorbidities.