During the last two decades, the development of appropriate use criteria (AUC), also known as appropriateness criteria, have been undertaken for many medical conditions and clinical scenarios with the goal of improving the quality, efficiency and cost-effectiveness of health care.
Appropriateness criteria determine when or how often a particular procedure should be performed in the context of:
- Available scientific evidence.
- Individual patient characteristics.
- Risk/benefit of treatment.
- Available health care resources.
Appropriateness criteria have been shown to improve patient selection for medical interventions and lead to improvements in diagnostic yield, clinical outcomes and patient-reported, health-related quality of life. They also can reduce overall cost and resource utilization.
Clinical guidelines often focus on more generalized, or disease-specific recommendations, whereas AUC are highly patient-centered and can provide physicians with detailed guidance about diagnostic or treatment approaches for a variety of patients and scenarios that occur in clinical practice.
The AUC facilitate this decision-making by deriving appropriate use determinations based on examining the available clinical evidence and supplementing this with the collective clinical experience and the judgment of a panel of physicians.
How AUC are developed
At the core of the AUC approach is the Appropriateness Method developed in the 1980s by RAND/UCLA. This method was devised to explain the variation in utilization of medical and surgical procedures observed across the country. Throughout the years, other organizations have further examined this methodology to adapt and refine it to enhance applicability in the clinical setting and credibility to external stakeholders.
The Mohs surgery AUC development process includes scoring for inappropriate, uncertain and appropriate procedures.
- Appropriate (Score 7-9): The use of the procedure is appropriate for the specific indication and is generally considered acceptable.
- Uncertain (Score 4-6): The use of the procedure is uncertain for the specific indication, although its use may be appropriate and acceptable. Uncertainty implies that more research is needed to classify the indication definitively.
- Inappropriate (Score 1-3): Use of the procedure is inappropriate for the specific indication and generally is not considered acceptable.
Through critical evaluation of the evidence and input of clinical expertise, the AUC are designed to ensure high-quality dermatological patient care while considering the many variables that affect clinical decision-making, including the use of available health care resources.