Perspective:

Increasingly, Appropriate Use Criteria are being used as a means to improve quality and reduce health care costs. Several prior studies have suggested that inappropriate tests have limited diagnostic and prognostic yield. Other studies have attempted to apply Appropriate Use Criteria to administrative data sets and large multi-institutional databases. These data suggest that these efforts be viewed with caution, as reliability in such assignments, even with full access to medical records, is limited. Importantly, although extensive training was a part of this study, no electronic or other tools were used to assist in application of the Acceptable Use Criteria. Several of these have been developed. Further, automated methods of assignment of appropriateness from administrative records have been previously used and were not evaluated here. Nonetheless, it is clear that improved, easy-to-use tools for application of Appropriate Use Criteria are necessary. Finally, one goal of future revisions of Appropriate Use Criteria may be to improve accessibility to clinicians.