Published 11/1/2012
Jayson Murray

Advancing Quality with Appropriate Use Criteria

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 have the distinct advantage of using clinicians’ “real-life” experiences and combining them with available evidence to produce realistic and practical criteria that can be applied to multiple patient profiles. Each patient profile represents a patient who has a specific set of indications, symptoms, or diseases.

To be clear, AUC are not meant to replace CPGs. In fact, AUC should be thought of as derivative products of CPGs, and both must begin with a systematic review of the literature. However, it is important to understand the differences between AUC and CPGs: CPGs inform clinicians “if” a procedure or treatment should be undertaken, whereas AUC inform clinicians “for whom” a procedure or treatment should be used.

AUC attempt to help guide a clinician’s decision before a procedure is performed. They should not be seen as a replacement for a clinician’s judgment, expertise, and/or experience.

AUC have many uses, including the following:

  • Aiding in clinical decision making
  • Preventing overuse and underuse of procedures or treatments across practices and regions
  • Catalyzing new research in areas where research is currently lacking
  • Producing educational and quality improvement tools
  • Filling in knowledge gaps where evidence is absent
  • Aiding in clinician—patient discussion

AAOS’ AUC efforts
The AAOS is currently developing AUC for various conditions. The first AUC, on the treatment of distal radius fractures, is scheduled for release in early 2013. More information about appropriate use criteria is available online at

Jayson Murray is the manager, appropriate use criteria, in the AAOS department of research & scientific affairs; he can be reached at jmurray@aaos.org