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Heterogeneity found in appropriate use criteria for imaging of CAD
U.S. Centers for Medicare & Medicaid Services (CMS)-qualified Appropriate Use Criteria (AUC) for imaging of coronary artery disease (CAD) are heterogeneous and discrepant, according to a study published online Aug. 22 in Annals of Internal Medicine.
David E. Winchester, M.D., from the University of Florida College of Medicine in Gainesville, and colleagues reviewed AUC published by CMS-qualified provider-led entities (PLEs) focusing on advanced imaging tests for CAD. Publicly available approved AUC with recommendations related to testing for CAD were included.
The researchers found that seven of the 17 CMS-qualified PLEs had published AUC relating to CAD. There was considerable variation in the methods and formatting of these AUCs. There was variation in the number of clinical scenarios covered, ranging from six to 210; the number of advanced imaging methods covered varied from one to 25. Many AUCs offered no guidance on appropriateness when specifically applied to clinical scenarios; those that did conflicted with respect to appropriateness.
"Substantial discrepancies in the scope, methods, and formatting of PLE-developed AUC for imaging in suspected CAD leave the AUC program vulnerable to clinician confusion and resistance possibly risking failure to achieve its intended effect on widespread clinical implementation," the authors write.
More information: David E. Winchester et al, The Medicare Appropriate Use Criteria Program: A Review of Recommendations for Testing in Coronary Artery Disease, Annals of Internal Medicine (2023). DOI: 10.7326/M23-1011
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