Claudia I Vidal1, Eric A Armbrect2, Aleodor A Andea3, Angela K Bohlke4, Nneka I Comfere5, Sarah R Hughes6, Jinah Kim7, Jessica A Kozel8, Jason B Lee9, Konstantinos Linos10, Brandon R Litzner11, Tricia A Missall12, Roberto A Novoa7, Uma Sundram13, Brian L Swick14, M Yadira Hurley12, Murad Alam15, Zsolt Argenyi16, Lyn M Duncan17, Dirk M Elston18, Patrick O Emanuel19, Tammie Ferringer20, Maxwell A Fung21, Gregory A Hosler22, Alexander J Lazar23, Lori Lowe3, Jose A Plaza24, Victor G Prieto23, June K Robinson25, Andras Schaffer26, Antonio Subtil27, Wei-Lien Wang28. 1. Departments of Dermatology and Pathology, Saint Louis University School of Medicine, Saint Louis, Missouri. Electronic address: vidalcmd@gmail.com. 2. Center for Health Outcomes Research, Saint Louis University, Saint Louis, Missouri. 3. Departments of Dermatology and Pathology, University of Michigan Medical Center, Ann Arbor, Michigan. 4. Silver Falls Dermatology, Salem, Oregon. 5. Department of Dermatology and Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota. 6. Department of Pathology, Gundersen Health System, La Crosse, Wisconsin. 7. Departments of Dermatology and Pathology, Stanford University School of Medicine, Stanford, California. 8. Midwest Pathology Associates, LLC, Overland Park, Kansas. 9. Departments of Dermatology and Cutaneous Biology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania. 10. Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center and Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire. 11. Departments of Dermatology and Pathology, Via Christi Clinic, Ascension Medical Group, Wichita, Kansas; Department of Family Medicine, University of Kansas Medical Center, Wichita, Kansas. 12. Departments of Dermatology and Pathology, Saint Louis University School of Medicine, Saint Louis, Missouri. 13. Department of Anatomic Pathology, Oakland University William Beaumont School of Medicine and Beaumont Health Systems, Royal Oak, Michigan. 14. Departments of Dermatology and Pathology, University of Iowa, Iowa City, Iowa. 15. Departments of Dermatology Otolaryngology, and Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois. 16. Department of Pathology, University of Washington, Seattle, Washington. 17. Pathology Service and Dermatopathology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts. 18. Department of Dermatology, Dermatologic Surgery Medical University of South Carolina, Charleston, South Carolina. 19. Department of Pathology and Molecular Medicine, University of Auckland, Auckland, New Zealand. 20. Departments of Dermatology and Laboratory Medicine, Geisinger Medical Center, Danville, Pennsylvania. 21. Departments of Dermatology and Pathology and Laboratory Medicine, University of California, Davis School of Medicine, Sacramento, California. 22. ProPath and Departments of Dermatology and Pathology, University of Texas Southwestern Medical Center, Dallas, Texas. 23. Departments of Pathology, Dermatology, and Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas. 24. Miraca Life Sciences, Irving, Texas. 25. Department of Dermatology, Northwestern University, Chicago, Illinois. 26. Bey Dermatology and Cosmetic Surgery, Spring Hill, Florida. 27. Department of Dermatology, Yale School of Medicine, New Haven, Connecticut. 28. Departments of Pathology and Translational Molecular Pathology, Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Abstract
BACKGROUND: Appropriate use criteria (AUC) provide physicians guidance in test selection, and can affect health care delivery, reimbursement policy, and physician decision-making. OBJECTIVES: The American Society of Dermatopathology, with input from the American Academy of Dermatology and the College of American Pathologists, sought to develop AUC in dermatopathology. METHODS: The RAND/UCLA appropriateness methodology, which combines evidence-based medicine, clinical experience, and expert judgment, was used to develop AUC in dermatopathology. RESULTS: With the number of ratings predetermined at 3, AUC were developed for 211 clinical scenarios involving 12 ancillary studies. Consensus was reached for 188 (89%) clinical scenarios, with 93 (44%) considered "usually appropriate" and 52 (25%) "rarely appropriate" and 43 (20%) having "uncertain appropriateness." LIMITATIONS: The methodology requires a focus on appropriateness without comparison between tests and irrespective of cost. CONCLUSIONS: The ultimate decision to order specific tests rests with the physician and is one where the expected benefit exceeds the negative consequences. This publication outlines the recommendations of appropriateness-the AUC for 12 tests used in dermatopathology. Importantly, these recommendations may change considering new evidence. Results deemed "uncertain appropriateness" and where consensus was not reached may benefit from further research.
BACKGROUND: Appropriate use criteria (AUC) provide physicians guidance in test selection, and can affect health care delivery, reimbursement policy, and physician decision-making. OBJECTIVES: The American Society of Dermatopathology, with input from the American Academy of Dermatology and the College of American Pathologists, sought to develop AUC in dermatopathology. METHODS: The RAND/UCLA appropriateness methodology, which combines evidence-based medicine, clinical experience, and expert judgment, was used to develop AUC in dermatopathology. RESULTS: With the number of ratings predetermined at 3, AUC were developed for 211 clinical scenarios involving 12 ancillary studies. Consensus was reached for 188 (89%) clinical scenarios, with 93 (44%) considered "usually appropriate" and 52 (25%) "rarely appropriate" and 43 (20%) having "uncertain appropriateness." LIMITATIONS: The methodology requires a focus on appropriateness without comparison between tests and irrespective of cost. CONCLUSIONS: The ultimate decision to order specific tests rests with the physician and is one where the expected benefit exceeds the negative consequences. This publication outlines the recommendations of appropriateness-the AUC for 12 tests used in dermatopathology. Importantly, these recommendations may change considering new evidence. Results deemed "uncertain appropriateness" and where consensus was not reached may benefit from further research.
Authors: Nicolas Ortonne; Steven L Carroll; Fausto J Rodriguez; Douglas C Miller; Rosalynn M Nazarian; Jaishri O Blakeley; Zachary B Madaj; Sharad K Verma; Anat Stemmer-Rachamimov Journal: Neurooncol Adv Date: 2019-12-05