Department of Medicine, Division of Cardiology, University of Miami Miller School of Medicine, FL, USA.
Am Heart J. 2011 Oct;162(4):772-9. doi: 10.1016/j.ahj.2011.07.009. Epub 2011 Sep 3.
In response to growth in cardiac imaging, medical societies have published appropriateness use criteria (AUC) and payers have introduced preauthorization mandates, largely through radiology benefits managers (RBM). The correlation of algorithms used to determine preauthorization with the AUC is unknown. In addition, studies applying the 2007 AUC for transthoracic echocardiography revealed that many echocardiograms could not be classified. We sought to examine the impact of the revised 2010 AUC on appropriateness ratings of transthoracic echocardiograms previously classified by the 2007 AUC and the relationship of preauthorization determination to AUC rating.
We reclassified indications for transthoracic echocardiography as appropriate, inappropriate, uncertain, or unclassifiable using the 2010 AUC in the same 625 patients previously reported using 2007 AUC. We also evaluated the relationship between preauthorization status by 2 RBM precertification algorithms and appropriateness rating by 2007 AUC.
The appropriateness classification of 148 (24%) transthoracic echocardiograms was changed by the updated AUC (P < .001). The number of unclassifiable echocardiograms was markedly reduced from 99 (16%) to 8 (1%), and more echocardiograms were classified as inappropriate (95 [15%] vs 45 [7%]) or uncertain (43 [7%] vs 0 [0%]). Limited correlation between the 2007 AUC rating and RBM preauthorization determinations was noted, with only moderate agreement with RBM no. 1 (90%, κ = 0.480, P < .001) and poor agreement with RBM no. 2 (72%, κ = 0.177, P < .001).
The updated AUC (2010) provide enhanced clinical value compared with 2007 AUC. There is limited agreement between RBM preauthorization determination and 2007 AUC rating.
随着心脏成像技术的发展，医学协会已经发布了适宜性使用标准（AUC），支付方也通过放射学福利管理者（RBM）引入了预先授权的规定。用于确定预先授权的算法与 AUC 的相关性尚不清楚。此外，应用 2007 年经胸超声心动图 AUC 的研究表明，许多超声心动图无法分类。我们试图研究修订后的 2010 年 AUC 对先前使用 2007 年 AUC 分类的经胸超声心动图的适宜性评分的影响，以及预先授权确定与 AUC 评分的关系。
我们使用 2010 年 AUC 重新分类了 625 例先前使用 2007 年 AUC 分类的经胸超声心动图的适应证，分为适宜、不适宜、不确定或无法分类。我们还评估了 2 个 RBM 预认证算法的预先授权状态与 2007 年 AUC 适宜性评分之间的关系。
更新后的 AUC 改变了 148 例（24%）经胸超声心动图的适宜性分类（P<0.001）。无法分类的超声心动图数量从 99 例（16%）明显减少到 8 例（1%），更多的超声心动图被分类为不适宜（95 例[15%]比 45 例[7%]）或不确定（43 例[7%]比 0 例[0%]）。我们注意到 2007 年 AUC 评分与 RBM 预先授权决定之间只有有限的相关性，与 RBM 1 号（90%，κ=0.480，P<0.001）有中度一致性，与 RBM 2 号（72%，κ=0.177，P<0.001）有较差的一致性。
与 2007 年 AUC 相比，更新后的 AUC（2010 年）提供了更高的临床价值。RBM 预先授权决定与 2007 年 AUC 评分之间的一致性有限。
