scholarly journals Assessing Strength of Evidence of Appropriate Use Criteria for Diagnostic Imaging Examinations

2016 ◽  
Vol 23 (3) ◽  
pp. 649-653 ◽  
Author(s):  
Ronilda Lacson ◽  
Ali S Raja ◽  
David Osterbur ◽  
Ivan Ip ◽  
Louise Schneider ◽  
...  
Keyword(s):  
Information Technology ◽  
Diagnostic Imaging ◽  
Expert Panel ◽  
Evidence Based ◽  
Appropriate Use Criteria ◽  
Appropriate Use ◽  
Medical Specialties ◽  
Framework Agreement ◽  
Strength Of Evidence ◽  
Measuring Agreement

Objective For health information technology tools to fully inform evidence-based decisions, recommendations must be reliably assessed for quality and strength of evidence. We aimed to create an annotation framework for grading recommendations regarding appropriate use of diagnostic imaging examinations. Methods The annotation framework was created by an expert panel (clinicians in three medical specialties, medical librarians, and biomedical scientists) who developed a process for achieving consensus in assessing recommendations, and evaluated by measuring agreement in grading the strength of evidence for 120 empirically selected recommendations using the Oxford Levels of Evidence. Results Eighty-two percent of recommendations were assigned to Level 5 (expert opinion). Inter-annotator agreement was 0.70 on initial grading (κ = 0.35, 95% CI, 0.23-0.48). After systematic discussion utilizing the annotation framework, agreement increased significantly to 0.97 (κ = 0.88, 95% CI, 0.77-0.99). Conclusions A novel annotation framework was effective for grading the strength of evidence supporting appropriate use criteria for diagnostic imaging exams.

scholarly journals Appropriate Use Criteria for the Integration of Diagnostic and Prognostic Gene Expression Profile Assays into the Management of Cutaneous Malignant Melanoma: An Expert Panel Consensus-Based Modified Delphi Process Assessment

2019 ◽  
Vol 3 (5) ◽  
pp. 291-306 ◽  
Author(s):  
Brian Berman ◽  
Roger Ceilley ◽  
Clay Cockerell ◽  
Laura Ferris ◽  
Whitney A High ◽  
...  
Keyword(s):  
Gene Expression ◽  
Expert Panel ◽  
Expression Profiles ◽  
Gene Expression Profiles ◽  
Evidence Based ◽  
Appropriate Use Criteria ◽  
Appropriate Use ◽  
Prognostic Gene ◽  
Modified Delphi ◽  
Clinical Scenarios

Background: Despite the clinical availability and widespread usage of diagnostic and prognostic gene expression profiles (GEP) for the management of melanoma, no recommendations for Appropriate Use Criteria (AUC) exist to guide their integration into clinical practice.Objective: To develop a set of consensus-based AUC recommendations for the use of GEP profiling technology in the diagnosis and management of melanoma in specifically-defined situations commonly encountered by the practicing dermatologist.Methods: A systematic Medline literature search was performed to identify all existing evidence pertinent to the clinical efficacy and utility of three melanoma GEP tests that met the inclusion criteria (validated in peer-reviewed literature, US governmentally approved, and currently widely used) for review. A modified Delphi technique was used to achieve consensus and standard SORT criteria were applied. An expert panel of nine dermatologists/dermatologic surgeons/dermatopathologists developed a set of 29 clinical scenarios for the appropriate use of GEP assays and reviewed the available literature to make evidence-based recommendations for each indication.Results: The 2-GEP assay for melanoma diagnosis received 1 B-strength and 6 C-strength recommendations. The 23-GEP diagnostic test received 1 A-strength, 3 B-strength, and 4 C-strength recommendations. The 31-GEP prognostic assay received 1 A-strength, 7 B-strength, and 6 C-strength recommendations.Conclusions: These AUC recommendations provide an evidence-based framework for the integration of melanoma GEP tests into clinical practice.

Commentary: Appropriate Use Criteria for Lumbar Degenerative Scoliosis: Developing Evidence-based Guidance for Complex Treatment Decisions

Neurosurgery ◽  
2017 ◽  
Vol 80 (3) ◽  
pp. E205-E212 ◽  
Author(s):  
Steven D. Glassman ◽  
Sigurd H. Berven ◽  
Christopher I. Shaffrey ◽  
Praveen V. Mummaneni ◽  
David W. Polly
Keyword(s):  
Treatment Decisions ◽  
Evidence Based ◽  
Complex Treatment ◽  
Appropriate Use Criteria ◽  
Appropriate Use ◽  
Degenerative Scoliosis

Discordance in Clinical Recommendations Regarding the Use of Imaging

2019 ◽  
Vol 35 (2) ◽  
pp. 117-124 ◽  
Author(s):  
Adam C. Powell ◽  
Teresa L. Rogstad ◽  
David E. Winchester ◽  
Jon D. Shanser ◽  
James W. Long ◽  
...  
Keyword(s):  
Selection Criteria ◽  
Clinical Decision ◽  
Evidence Based ◽  
Appropriate Use Criteria ◽  
Appropriate Use ◽  
Clinical Recommendations ◽  
Quantitative Studies ◽  
Clinical Recommendation ◽  
Pubmed Database ◽  
Evidence Based Care

As physicians strive to provide evidence-based care, challenges arise if different entities disseminate divergent Appropriate Use Criteria (AUC) or clinical guidelines on the same topic. To characterize these challenges in one field, this study reviews the literature on comparisons of clinical recommendations regarding medical imaging. The PubMed database was searched for the years 2013-2018 for studies describing discordance among clinical recommendations regarding the performance of imaging. Of the 406 articles identified, 15 met the selection criteria: 8 qualitative and 7 quantitative. Reasons for discordance varied, with lack of evidence often cited. Quantitative studies often found that different decisions would be reached depending on the clinical recommendation followed. Nonetheless, quantitative studies also tended not to consider one set of recommendations superior to another. The findings of this review might help clinicians seek guidance more thoughtfully and could inform use of guidelines and AUC for quality improvement and clinical decision support.

Evidence-Based Medicine, Appropriate-Use Criteria, and Sports Medicine: How Best to Develop Meaningful Treatment Guidelines

2013 ◽  
Vol 29 (7) ◽  
pp. 1224-1229 ◽  
Author(s):  
Louis F. McIntyre ◽  
William R. Beach ◽  
Laurence D. Higgins ◽  
Margaret M. Mordin ◽  
Josephine Mauskopf ◽  
...  
Keyword(s):  
Evidence Based Medicine ◽  
Sports Medicine ◽  
Treatment Guidelines ◽  
Evidence Based ◽  
Appropriate Use Criteria ◽  
Appropriate Use ◽  
Based Medicine

scholarly journals An Evidence-Based Tool for Safe Configuration of Electronic Health Records: The eSafety Checklist

2018 ◽  
Vol 09 (04) ◽  
pp. 817-830 ◽  
Author(s):  
Pritma Dhillon-Chattha ◽  
Ruth McCorkle ◽  
Elizabeth Borycki
Keyword(s):  
Health Care ◽  
Information Technology ◽  
Electronic Health Records ◽  
Health Information Technology ◽  
Health Information ◽  
Expert Panel ◽  
Clinical Informatics ◽  
Evidence Based ◽  
Health Records ◽  
Electronic Health

Background Electronic health records (EHRs) are transforming the way health care is delivered. They are central to improving the quality of patient care and have been attributed to making health care more accessible, reliable, and safe. However, in recent years, evidence suggests that specific features and functions of EHRs can introduce new, unanticipated patient safety concerns that can be mitigated by safe configuration practices. Objective This article outlines the development of a detailed and comprehensive evidence-based checklist of safe configuration practices for use by clinical informatics professionals when configuring hospital-based EHRs. Methods A literature review was conducted to synthesize evidence on safe configuration practices; data were analyzed to elicit themes of common EHR system capabilities. Two rounds of testing were completed with end users to inform checklist design and usability. This was followed by a four-member expert panel review, where each item was rated for clarity (clear, not clear), and importance (high, medium, low). Results An expert panel consisting of three clinical informatics professionals and one health information technology expert reviewed the checklist for clarity and importance. Medium and high importance ratings were considered affirmative responses. Of the 870 items contained in the original checklist, 535 (61.4%) received 100% affirmative agreement among all four panelists. Clinical panelists had a higher affirmative agreement rate of 75.5% (656 items). Upon detailed analysis, items with 100% clinician agreement were retained in the checklist with the exception of 47 items and the addition of 33 items, resulting in a total of 642 items in the final checklist. Conclusion Safe implementation of EHRs requires consideration of both technical and sociotechnical factors through close collaboration of health information technology and clinical informatics professionals. The recommended practices described in this checklist provide systems implementation guidance that should be considered when EHRs are being configured, implemented, audited, or updated, to improve system safety and usability.

Abstract 239: Appropriateness and Impact of Transthoracic Echocardiography in a Veterans Affairs Health Care System.

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Kazeen N Abdullah ◽  
Jeff Hastings ◽  
Shuaib Abdullah ◽  
Susan Matulevicius
Keyword(s):  
Health Care ◽  
Diagnostic Imaging ◽  
Transthoracic Echocardiography ◽  
Veterans Affairs ◽  
Clinical Impact ◽  
Appropriate Use Criteria ◽  
Appropriate Use ◽  
Transplant Patients ◽  
Medical Centers ◽  
Active Change

Background: Appropriate Use Criteria (AUC) for transthoracic echocardiograms (TTEs) was developed in 2007 and later revised in 2011 to meet the need for guidance on appropriate use of diagnostic imaging. Few studies have evaluated the correlation between AUC and downstream clinical impact. We describe the association of AUC and clinical impact for TTEs from a VA center. Methods: All TTEs from April 2011 at a VA center were retrospectively reviewed. TTEs were excluded for LVAD/ transplant patients or for inadequate clinical data to assign AUC or clinical impact. Based on 2011 AUC , TTEs were classified as: appropriate, inappropriate, or uncertain. After blinding to AUC, TTEs were assessed for clinical impact as: change in care, continuation of current care, or no change in care. Results: Among 441 TTEs (43% inpatient), 82.7% were appropriate, 9% inappropriate and 8% uncertain. Overall, change of care was seen in 39% of TTEs, continuation of current care in 32% and no change in care in 30%. Appropriate TTEs more frequently resulted in a change in care than inappropriate TTEs (41% vs. 23%, p<0.03, Figure 1). Conclusions: Although only 8 in 10 TTEs were appropriate by 2011 AUC, almost 4 in 10 TTEs lead to an active change in care. Appropriate TTEs were more likely to change patient care than inappropriate TTEs. Additional research is needed to evaluate the association of clinical impact and differences in TTE practice at VA vs. non VA medical centers.

scholarly journals IMPLEMENTATION OF EVIDENCE-BASED CLINICAL-AND-MORPHOLOGICAL APPROPRIATE USE CRITERIA FOR CORONARY REVASCULARIZATION IN PATIENTS WITH ACUTE CORONARY SYNDROME IN RUSSIA

2014 ◽  
Vol 13 (2) ◽  
pp. 24-28 ◽  
Author(s):  
Yu. V. Popova ◽  
O. M. Posnenkova ◽  
A. R. Kiselev ◽  
V. I. Gridnev ◽  
P. Ya. Dovgalevsky
Keyword(s):  
Acute Coronary Syndrome ◽  
Coronary Revascularization ◽  
High Technology ◽  
Evidence Based ◽  
Expert Evaluation ◽  
Appropriate Use Criteria ◽  
Appropriate Use ◽  
Coronary Syndrome ◽  
Morphological Criteria ◽  
Percutaneous Coronary

Aim. To study possibility of using the evidence-based clinical-andmorphological appropriate use criteria for percutaneous coronary interventions (PCIs) for expert evaluation of high-technology procedures implementation in patients with acute coronary syndrome (ACS) in Russia.Materials and methods. The appropriateness of performed PCI was assessed in patients with ACS, underwent coronary revascularization. The potential need in PCI was determined in ACS patients refused from coronary revascularization. Assessment was performed with the help of ACCF/SCAI/STS/AATS/AHA/ASNC/HFSA/SCCT 2012 Appropriate Use Criteria for Coronary Revascularization Focused Update (ACCF 2012). Data from 65,912 ACS patients, containing in Russian ACS Registry (2010–2011) were examined.Results. ACCF 2012 criteria allow to assess the clinical appropriateness of PCI in 79.2% of patients underwent coronary revascularization and to determine the potential need in PCI in 80.6% of patients, refrained from coronary revascularization. Among ACS patients underwent PCI (n=9147), intervention was appropriate in 68.9% of cases. Inappropriate PCI was revealed in 4.6% of cases. Among patients refrained from PCI (n=56765), coronary revascularization was potentially appropriate in 57.9% of cases.Conclusion. ACCF 2012 clinical-and-morphological criteria allow to judge on appropriateness of performed PCI and to evaluate the potential need in PCI among the most part of Russian ACS patients. In present study coronary revascularization was appropriate in the majority of ACS patients. It was shown possible to use the evidence-based clinical-andmorphological criteria for expert evaluation of high-technology procedures implementation in Russian ACS patients.

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