Appropriate use criteria in dermatopathology: Initial recommendations from the American Society of Dermatopathology

作者：Vidal Claudia I; Armbrect Eric A; Andea Aleodor A; Bohlke Angela K; Comfere Nneka I; Hughes Sarah R; Kim Jinah; Kozel Jessica A; Lee Jason B; Linos Konstantinos; Litzner Brandon R; Missall Tricia A; Novoa Roberto A; Sundram Uma; Swick Brian L; Hurley Maria Yadira; Alam Murad; Argenyi Zsolt; Duncan Lyn M; Elston Dirk M; Emanuel Patrick O; Ferringer Tammie; Fung Maxwell A; Hosler Gregory A; Lazar Alexander J; Lowe Lori; Plaza Jose A; Prieto Victor G

来源：Journal of Cutaneous Pathology, 2018, 45(8): 563-580.

DOI：10.1111/cup.13142

• ancillary studies
• appropriate use criteria
• dermatopathology
• evidence-based medicine
• expert rating

BackgroundAppropriate use criteria (AUC) provide physicians guidance in test selection, and can affect health care delivery, reimbursement policy and physician decision-making.
ObjectivesThe American Society of Dermatopathology, with input from the American Academy of Dermatology and the College of American Pathologists, sought to develop AUC in dermatopathology.
MethodsThe RAND/UCLA appropriateness methodology, which combines evidence-based medicine, clinical experience and expert judgment, was used to develop AUC in dermatopathology.
ResultsWith 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, 52 (25%) rarely appropriate and 43 (20%) uncertain appropriateness.
LimitationsThe methodology requires a focus on appropriateness without comparison between tests and irrespective of cost.
ConclusionsThe ultimate decision of when to order specific test rests with the physician and is one where the expected benefit exceeds the negative consequences. This publication outlines the recommendations of appropriatenessAUC 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.

• 出版日期2018-8