Division of Cardiology, University of Utah Health, Salt Lake City, Utah.
Advocate Illinois Masonic Medical Center, Chicago, Illinois.
Catheter Cardiovasc Interv. 2019 Apr 1;93(5):875-879. doi: 10.1002/ccd.27931. Epub 2018 Oct 8.
The American College of Cardiology (ACC) Interventional Section Council leadership sought to examine the views of interventional cardiologists regarding the practical implementation and the value of the Appropriate Use Criteria (AUC) in their clinical practice.
The ACC AUC for revascularization were originally intended to assess trends in revascularization patterns by hospitals and physicians to ensure that both under- and over-utilization were minimized. As a quality assurance tool, the AUC were designed to allow physicians to obtain insight into their practice patterns and improve their practice. Recent trends toward tying payment to performance have raised concerns that these criteria will be incorrectly applied to individual patient reimbursement, which is not what they were designed to do. Consequently, the AUC have become controversial, not for their value in quality assessment, but for the manner in which agencies have used the AUC as a tool to potentially deny payment for certain patients.
Utilizing an online survey, members of the ACC Interventional Section were queried regarding the use of AUC, how they use them, and how they feel utilization impacts the care of patients.
We found substantial variability in how the AUC were utilized and concern regarding the value of AUC. Among our findings was that respondents were split (51% vs 49%) regarding the value of AUC to patients and/or their laboratory.
In this article, we discuss the implications of these findings and consider options on how AUC might be made a better-accepted and more impactful tool for clinicians and patients.
美国心脏病学会（ACC）介入科委员会领导层希望调查介入心脏病专家对 AUC 在临床实践中的实际应用和价值的看法。
最初，ACC 血管重建术 AUC 的目的是评估医院和医生的血管重建模式趋势，以确保最大限度地减少过度和不足利用。作为质量保证工具，AUC 的设计目的是让医生了解自己的实践模式并改进实践。最近将支付与绩效挂钩的趋势引发了人们的担忧，即这些标准将被错误地应用于个别患者的报销，这不是它们的设计目的。因此，AUC 变得有争议，不是因为它们在质量评估方面的价值，而是因为机构将 AUC 用作潜在拒绝某些患者支付的工具的方式。
利用在线调查，询问 ACC 介入科的成员有关 AUC 的使用、他们如何使用 AUC 以及他们如何看待利用率对患者护理的影响。
我们发现 AUC 的使用方式存在很大差异，并且对 AUC 的价值存在担忧。我们的发现之一是，受访者在 AUC 对患者及其实验室的价值方面存在分歧（51% 对 49%）。
在本文中，我们讨论了这些发现的影响，并考虑了如何使 AUC 成为更受临床医生和患者接受和更具影响力的工具的选择。
