QUALITY AND APPROPRIATENESS IN CARDIAC IMAGING

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WHAT IS AN APPROPRIATE IMAGING STUDY An appropriate imaging study is one in which the expected incremental information, combined with clinical judgment, exceeds the expected negative consequences* by a sufficiently wide margin for a specific indication that the procedure is generally considered acceptable care and a reasonable approach for the indication. *Negative consequences include the risks of the procedure (i.e., radiation or contrast exposure) and the downstream impact of poor test performance such as delay in diagnosis (false negatives) or inappropriate diagnosis (false positives).
APPROPRIATE USE CRITERIA USING THE RAND/DELPHI METHODOLOGY Writing Group Literature Review and Synthesis of the Evidence List of indications and definitions External Reviewers Technical Panel Implementation Working Group Validation Appropriateness Determination Outside Review of Indications and Additional Modification Prior to Rating Balanced panel comprised of different types of experts rates the indications in two rounds 1 st Round – No interaction Face-to-Face Meeting 2 nd Round – Panel interaction Appropriateness Score (7-9) Appropriate (4-6) Possibly Appropriate/Uncertain (1-3) Inappropriate Retrospective comparison with clinical records Prospective clinical decision aids % Use that is Appropriate, Uncertain, Inappropriate Increase Appropriateness dapted from Fitch K, et al. The RAND/UCLA Appropriateness Method User’s Manual, 2001, 4
Page 1 and 2: ACOI’s 69 th ANNUAL CONVENTION AN
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Page 11 and 12: WHY APPROPRIATENESS Background •
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QUALITY AND APPROPRIATENESS IN CARDIAC IMAGING

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