Appropriate Use Criteria

What are Appropriate Use Criteria?

Appropriate Use Criteria (AUC) specify 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. Often sound data are not available, or they do not provide evidence that is detailed enough to apply to the full range of patients seen in everyday clinical practice. Nevertheless, physicians must make daily decisions about when to use or not use a particular procedure. AUC’s facilitate these decisions by combining the best available scientific evidence with the collective judgment of physicians from in order to determine the appropriateness of performing a procedure.

What procedures are addressed by Appropriate Use Criteria?

AUC topics focus on widely and frequently used procedures whose effectiveness is supported by evidence-based information. Additionally, AUC topics could be procedures that consume significant resources, have wide variations in their use (e.g. geographic), or are associated with substantial morbidity and mortality. AUC topics are derived from AAOS Clinical Practice Guidelines that establish the effectiveness of various procedures for a given disease, disorder or condition. AUC’s then address the patients in which these procedures are appropriate given the nuances of everyday clinical practice.

Why develop Appropriate Use Criteria?

AUC’s are developed to ensure the highest QUALITY of care for patients undergoing musculoskeletal procedures.

How are Appropriate Use Criteria developed?

The AAOS uses the RAND/UCLA Appropriateness Method to develop AUC’s. AAOS AUC’s are developed using evidence-based information in conjunction with the clinical expertise of physicians from multiple medical specialties in order to improve patient care and obtain the best outcomes while considering the subtleties and distinctions necessary in making clinical decisions.

Table 1 shows the RAND/UCLA Appropriateness Method

Who develops Appropriate Use Criteria?

“Panels” of AAOS volunteer physicians that operate independently of each other develop AAOS Appropriate Use Criteria.

The “Writing” panel combines clinical and procedural expertise with evidence-based information from Clinical Practice Guideline(s) to define and describe the criteria for a procedure. This is accomplished by listing clinical indications that impact the outcomes of a procedure, and are common in everyday clinical practice, into scenarios.

The “Voting” panel utilizes clinical expertise of physicians from multiple medical specialties and evidence based information to assign ratings of appropriateness to each scenario developed by the “Writing” group. These ratings are made using a modified Delphi technique described by the RAND/UCLA Appropriateness Method. At least two rounds of ratings are made by this panel, the first is conducted anonymously and the second is conducted at a face-to-face meeting at the Academy headquarters.

More about Appropriate Use Criteria

AAOS Now August 2011 Coming soon: Appropriate use criteria