APPROPRIATE USE CRITERIA Appropriate Use of Cardiovascular Technology 2013 ACCF Appropriate Use Criteria Methodology Update A Report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force Appropriate Use Criteria Task Force Robert C. Hendel, MD, FACC, FAHA, FASNC Manesh R. Patel, MD, FACC Joseph M. Allen, MA James K. Min, MD, FACC Leslee J. Shaw, PHD, FACC, FASNC, FAHA Michael J. Wolk, MD, MACC Pamela S. Douglas, MD, MACC, FAHA, FASE Christopher M. Kramer, MD, FACC, FAHA Raymond F. Stainback, MD, FACC, FASE Steven R. Bailey, MD, FACC, FSCAI, FAHA John U. Doherty, MD, FACC, FAHA Ralph G. Brindis, MD, MPH, MACC, FSCAI, ex officio Introduction The past several decades have seen rapid and extensive changes in the practice of cardiology, especially in the innovation and utilization practices of imaging, interven- tional, and electrophysiology procedures. Enhanced radio- nuclide imaging techniques, evolution of echocardiography, development of cardiac magnetic resonance (MR), and coronary computed tomography (CT) angiography tech- niques, as a well as drug-eluting stents and cardiovascular implantable electronic devices, have revolutionized how patients are diagnosed and treated. Although these devel- opments have resulted in direct patient benefits including improved survival and enhanced quality of life, there has been an accompanying increase in resource utilization and healthcare costs. Although declines in utilization of many cardiovascular procedures have been observed as of late, during the years preceding 2005, the growth rates were at times substantial as these technologies were adopted. The perceived high rate of growth of expenditures related to cardiovascular procedures has precipitated payers to initiate utilization constraints to markedly reduce spending and reimbursement. Various payer initiatives have created an onerous burden leading to costly administrative require- ments, including physician profiling and prior authorization (1). These general programs are also, in part, driven by marked geographic variability in utilization, which under- score the need for further guidance regarding optimal patient selection for procedures (2,3). Professional efforts to better define quality have identified the importance of matching procedures and patients (4). In response to the imperative for improving the utiliza- tion of cardiovascular procedures in an efficient and con- temporary fashion, the American College of Cardiology Foundation (ACCF), along with imaging subspecialty so- cieties and other organizations, developed the first set of Appropriate Use Criteria (AUC) in 2005, focusing on indications for radionuclide imaging (5). A concurrent publication defined in some detail the methods involved in the construction of these criteria (6). During the ensuing 7 years, there have been numerous other AUC publications (Figure 1)—including revisions to several of the original criteria—that reflect expansion of the AUC concept and advances within the specific disciplines, as well as method- ological changes. The aim of the current paper is to review recent modifications in the methods for developing AUC, most notably substantial alterations in the nomenclature employed for appropriateness categorization (detailed later in the text). Although the methods for AUC construction have evolved, the core process remains rooted in the application of the validated, prospectively based modified RAND Ap- propriateness Method (7,8) as was described in the initial methods article (6). Readers interested to learn more about the RAND method and adaptations developed by ACCF are encouraged to review these papers, as well as the current paper. Because the RAND method offered a general ap- proach to constructing criteria, most of the approaches This document was approved by the American College of Cardiology Foundation Board of Trustees in January 2013. The American College of Cardiology Foundation requests this document be cited as follows: Hendel RC, Patel MR, Allen JM, Min JK, Shaw LJ, Wolk MJ, Douglas PS, Kramer CM, Stainback RF, Bailey SR, Doherty JU, Brindis RG. Appropriate Use of Cardiovascular Technology: 2013 ACCF Appro- priate Use Criteria Methodology Update. J Am Coll Cardiol 2013;61:1305–17. http://dx.doi.org/10.1016/j.jacc.2013.01.025. Copies: This document is available on the World Wide Web site of the American College of Cardiology (http://www.cardiosource.org). For copies of this document, please contact Elsevier Inc. Reprint Department, fax (212) 633-3820, e-mail reprints@elsevier.com. Permissions: Multiple copies, modification, alteration, enhancement, and/or dis- tribution of this document are not permitted without the express permission of the American College of Cardiology Foundation. Please contact Elsevier’s permission department at healthpermissions@elsevier.com. Journal of the American College of Cardiology Vol. 61, No. 12, 2013 © 2013 by the American College of Cardiology Foundation ISSN 0735-1097/$36.00 Published by Elsevier Inc. http://dx.doi.org/10.1016/j.jacc.2013.01.025 brought to you by CORE View metadata, citation and similar papers at core.ac.uk provided by Elsevier - Publisher Connector