scholarly journals Appropriate Use Criteria for Hyaluronic Acid in the Treatment of Knee Osteoarthritis in the United States

Cartilage ◽  
2016 ◽  
Vol 8 (3) ◽  
pp. 234-254 ◽  
Author(s):  
Arup K. Bhadra ◽  
Roy Altman ◽  
Vinod Dasa ◽  
Karen Myrick ◽  
Jeffrey Rosen ◽  
...  
Keyword(s):  
Hyaluronic Acid ◽  
Sports Medicine ◽  
The United States ◽  
Current Evidence ◽  
Appropriate Use Criteria ◽  
Appropriate Use ◽  
Appropriateness Criteria ◽  
Knee Oa ◽  
Clinical Scenarios ◽  
Patient Scenario

Objective: A workgroup of clinical experts has developed an Appropriate Use Criteria (AUC) for the use of hyaluronic acid (HA) in the treatment of osteoarthritis (OA) of the knee. The increasingly broad and varied use of HA injections, lack of published clinical guidance, and limited coverage for their use has created the imperative to establish appropriateness criteria. Methods: The experts of this workgroup represent rheumatology, orthopedic surgery, physiatry, sports medicine, and nursing clinicians with substantive knowledge of intra-articular HA therapy. This workgroup utilized the results of a systematic review of evidence, expert clinical opinion, and current evidence-based clinical practice guidelines to develop appropriateness criteria for the use of intra-articular HA for knee OA in 17 real-world clinical scenarios. Results: The workgroup scored the appropriateness of treatment of each patient scenario using a 9-point scale to designate a treatment as appropriate (7-9), uncertain (4-6), or inappropriate (1-3). Six scenarios were scored as appropriate, 10 scenarios were scored as uncertain, and 1 scenario was scored as inappropriate. Conclusion: This article can assist clinicians in shared decision-making by providing best practices in considering HA injections for knee OA treatment. Moreover, this AUC article can aid payers and policy makers in determining reimbursement and preauthorization policies and more appropriately managing health care resources. It is clear that further research is still necessary—particularly in patient populations differentiated by OA severity—that may benefit the greatest from the use of HA injections for the treatment of knee OA.

scholarly journals Rheological Properties of Commercially Available Hyaluronic Acid Products in the United States for the Treatment of Osteoarthritis Knee Pain

2018 ◽  
Vol 11 ◽  
pp. 117954411775162 ◽  
Author(s):  
Mathew Nicholls ◽  
Ajay Manjoo ◽  
Peter Shaw ◽  
Faizan Niazi ◽  
Jeffrey Rosen
Keyword(s):  
United States ◽  
Hyaluronic Acid ◽  
Rheological Properties ◽  
Cone Angle ◽  
The United States ◽  
Molecular Structures ◽  
Rheological Parameters ◽  
Future Research ◽  
Knee Oa ◽  
Semidilute Solution

Objective: The inconsistent results within the current literature regarding the efficacy of intra-articular-hyaluronic acid (IA-HA) for the treatment of knee osteoarthritis (OA) have been suggested to be due to intrinsic differences between individual HA products. The purpose of this investigation is to define the rheological differences between currently available HA products in the United States at the time of this study for the treatment of knee OA, which will help elaborate on the appropriateness of classifying HA products as a class opposed to as individual agents. Methods: The rheological parameters for Euflexxa, Orthovisc, Supartz, Monovisc, Synvisc, Synvisc-One, Gel-One, and Hyalgan were obtained with a TA AR 2000 EX Rheometer with a cone-plate geometry (40-mm plate diameter and a 2° cone angle) at room temperature. Results: The bulk rheological parameters of the different products suggest molecular structures traversing the range of dilute solution (Hyalgan, Supartz), semidilute solution (Euflexxa, Orthovisc), entangled solutions (Monovisc, Synvisc, Synvisc-One), and even gel-like (Gel-One) behavior. Conclusions: Due to the differences in rheological properties between IA-HA products, the universal assessment of these products as a class may not be appropriate. Instead, it may be more appropriate to assess each product individually. Future research should aim to link these differences in rheological properties to the differences in clinical efficacy seen across these IA-HA products.

scholarly journals Appropriate Use Criteria and the Imaging Mandate

2017 ◽  
pp. 1
Author(s):  
Gregory J Dehmer ◽  
Leah White ◽  
John U Doherty ◽  
◽  
◽  
...  
Keyword(s):  
Imaging Modality ◽  
Clinical Care ◽  
Cost Savings ◽  
Appropriate Use Criteria ◽  
Appropriate Use ◽  
Testing Procedures ◽  
Multiple Imaging ◽  
Clinical Scenarios ◽  
Unnecessary Procedures

Appropriate use criteria (AUC) have existed for over 30 years and are being deployed with increasing frequency to study the delivery of healthcare. The goal of AUC is to advise all stakeholders about the reasonable use of testing procedures or therapies to improve symptoms, quality of life, and health outcomes. Numerous studies have shown the favorable effects of AUC to limit the overuse of unnecessary procedures while also promoting high-quality clinical care and cost savings. AUC evaluating only a single imaging modality have been replaced by multimodality documents, making it easier for the clinician to evaluate the appropriateness of multiple imaging methods in various clinical scenarios. The Protecting Access to Medicare Act of 2014 contained language mandating the use of AUC when ordering certain advanced cardiac imaging tests, and this requirement is currently scheduled for implementation in January 2020. Clinicians need to be aware of the increasing use of AUC and the financial implications of the AUC mandate legislation.

Abstract 365: Improving Hospital Adherence to The Appropriate Use Criteria; A Successful Multidisciplinary, Multipronged Approach

2015 ◽  
Vol 8 (suppl_2) ◽  
Author(s):  
Lisa A Wilbert ◽  
William E Lawson ◽  
Elisa Horbatuk ◽  
Susan Boudreau ◽  
Deneen Hastings ◽  
...  
Keyword(s):  
New York ◽  
Task Force ◽  
Coronary Revascularization ◽  
New York State ◽  
Appropriate Use Criteria ◽  
Appropriate Use ◽  
Appropriateness Criteria ◽  
Chi Square ◽  
Effective Implementation ◽  
Policies And Procedures

Background: New York State (NYS) began monitoring and reporting back hospital’s adherence to the Appropriate Use Criteria for Coronary revascularization (AU) in 2010. NYS plans to publicly report as well as decrease payments for procedures deemed rarely appropriate based on these data. Utilizing the data in these reports on AU, our hospital made strenuous efforts to improve documentation and decrease inappropriate procedures. Results from NYS data from 2011 through 2013 were continuously tracked and charted to monitor progress and to identify areas to focus on for needed remediation. Methods: 2010 data from NYS was utilized as the baseline. A multipronged approach was taken to improve appropriateness. A monthly multidisciplinary task force was organized to review opportunities, change policies and procedures, and review ongoing results. A worksheet was developed and used to provide education and data collection. The electronic catheterization report was changed to incorporate appropriateness criteria documentation previously missing from the chart. Challenges included education and achieving compliance from a diverse group of faculty captive and private cardiology groups supported by a large and constantly changing group of support staff. The summary of data from NYS was compared from 2010 through 2013 against the hospitals results and NYS as a whole. Results: Cases rated appropriate increased from 26% (102 of 391) in 2010 to 62% (75 of 121) in 2013. Cases rated inappropriate decreased from 24.8% (97 of 391) in 2010 to 8.3% (10 of 121) in 2013. The cases rated uncertain also decreased from 49% (192 of 391) in 2010 to 29.8% (36 of 121) in 2013. This is statistically significant with p < 0.05 by chi-square. Conclusions: Appropriate use dramatically improved with the effective implementation of a multipronged strategy utilizing: a task force, AU worksheet, electronic documentation tools, data review, practitioner feedback and education. Compliance with appropriate use metrics is assuming increasing importance with QHIP in 2015 designating 2 AU measures (unclassifiable and inappropriate) as determinants of hospital payments. Our effective improvement of AU results serves as an institutional template for other ongoing quality improvement efforts.

Abstract 241: Utility and Appropriateness of Echocardiography - Insights from Nonagenarians

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Thomas Delmas ◽  
Allan Anderson ◽  
Brian Barnett
Keyword(s):  
Statistical Significance ◽  
The United States ◽  
Continuous Variable ◽  
Clinical Service ◽  
Entire Group ◽  
P Value ◽  
Appropriate Use Criteria ◽  
Appropriate Use ◽  
Significant Information ◽  
Exact Test

Background: More than 20 million echocardiograms are performed every year in the United States at an average cost of approximately five hundred dollars per study. Despite this large expense, these studies can provide significant information that influences patient care. In the fast growing segment of nonagenarians, we sought to determine if echocardiograms have been appropriately obtained according to current Appropriate Use Criteria (AUC). Methods: Over a one-year period at Baylor Scott and White Memorial Hospital, the following characteristics of echocardiography cases performed for elderly patients (90 years and older) were summarized according to Appropriate Use Criteria class: age, gender, patient origin (inpatient/outpatient), type of study (TTE/TEE), and clinical service. Each characteristic was compared among 3 AUC classes (appropriate, inappropriate, and undetermined). ANOVA or Kruskal-Wallis test was used for continuous variable comparisons and Chi-square test or Fisher’s exact test was used for categorical variable comparisons. Proportion (95% confidence interval (CI)) of cases that received echocardiography due to appropriate reasons was estimated for entire group. A p-value of less than 0.05 indicated a statistical significance. Results: Four hundred eighty cases that met inclusion criteria were included in the analysis. Among 480 cases, 91% (435 cases, 95% CI (88-93%)) were conducted due to appropriate reasons. Four percent (21 cases, 95% CI (3-7%)) were performed due to inappropriate reasons and 5% (24 cases, 95% CI (3-7%)) were done due to undetermined reasons. There were no significant differences among the three AUC classes by age, gender, or type of study. However, there are significant differences (P<0.05) among the three AUC classes in regards to clinical service requesting the study and site of origin of the patient. Conclusions: 9% of echocardiograms performed in this demographic, including 26% of outpatient studies, were not appropriate according to current AUC. There was significant variance between referring service and by site of origin. Investigation in larger groups of patients may provide enhanced awareness of and improved adherence to AUC.

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 A Systematic Review of Current Clinical Practice Guidelines on Intra-articular Hyaluronic Acid, Corticosteroid, and Platelet-Rich Plasma Injection for Knee Osteoarthritis: An International Perspective

2021 ◽  
Vol 9 (8) ◽  
pp. 232596712110302
Author(s):  
Mark Phillips ◽  
Mohit Bhandari ◽  
John Grant ◽  
Asheesh Bedi ◽  
Thomas Trojian ◽  
...  
Keyword(s):  
Systematic Review ◽  
Hyaluronic Acid ◽  
Clinical Practice ◽  
Knee Osteoarthritis ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Platelet Rich Plasma ◽  
Symptom Relief ◽  
Current Evidence ◽  
Knee Oa

Background: There are many clinical practice guidelines (CPGs) for the prevention, diagnosis, and treatment of knee osteoarthritis (OA). They differ by region, considering local health care systems, along with cultural and economic factors. Currently, there are conflicting CPG recommendations across the various publications, which makes it difficult for clinicians to fully understand the optimal treatment decisions for knee OA management. Purpose: To summarize the current published CPG recommendations for the role of injections in the nonoperative management of knee OA, specifically with the use of intra-articular hyaluronic acid (IA-HA), intra-articular corticosteroids (IA-CS), and platelet-rich plasma (PRP). Study Design: Systematic review. Methods: A comprehensive search identified all nonoperative knee OA CPGs within the ECRI (formerly Emergency Care Research Institute) Guidelines Trust database, the Guidelines International Network database, Google Scholar, and the Trip (formerly Turning Research Into Practice) database. Guideline recommendations were categorized into strong, conditional, or uncertain recommendations for or against the use of IA-HA, IA-CS, or PRP. Guideline recommendations were summarized and depicted graphically to identify trends in recommendations over time. Results: The search strategy identified 27 CPGs that provided recommendations. There were 20 recommendations in favor of IA-HA use, 21 recommendations in favor of IA-CS use, and 9 recommendations that were uncertain or unable to make a formal recommendation for or against PRP use based on current evidence. Most recommendations considered IA-HA and IA-CS use for symptom relief when other nonoperative options are ineffective. IA-CS were noted to provide fast and short-acting symptom relief for acute episodes of disease exacerbation, while IA-HA may demonstrate a relatively delayed but prolonged effect in comparison. The CPGs concluded that PRP recommendations currently lack evidence to definitively recommend for or against use. Conclusion: Available CPGs provide recommendations on injectables for knee OA treatment. General guidance from a global perspective concluded that IA-CS and IA-HA are favored for different needed responses and can be utilized within the knee OA treatment paradigm, while PRP currently has insufficient evidence to make a conclusive recommendation for or against its use.

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.

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