Appropriate Use Criteria
Current patterns of utilization of procedures are characterized by significant regional variation. Faced with uncertainties about the true nature of current utilization rates and patterns, clinicians, payers, and patients are demanding criteria to evaluate the "appropriateness" of cardiovascular services, especially for imaging. The ACC believes that a careful blending of evidence-based information and clinical experience can help guide a more efficient and equitable allocation of health care resources. The ultimate objective of the criteria is to improve patient care and health outcomes in a cost-effective manner, without constraining the crucial role of physician judgment in the face of diverse clinical presentations and varying patient characteristics. Unlike comprehensive guidelines, Appropriate Use Criteria (AUC) focus on the most common patient scenarios for which procedures may be considered. The documents help define when it is reasonable to perform a procedure and importantly when it is not reasonable. The Solution Set Oversight Committee has oversight of AUC development, through appointment of content development work groups and rating panels. The rating panels employ a modified Delphi process to rate individual patient scenarios. Current scientific evidence is provided as one element for consideration during rating but cost, other tests, and physician judgment also are implicitly considered. Appropriate Use Criteria are published in JACC.
Clinical Alerts are generally short (one- to two-page) scientific statements that are developed in response to a clinical issue that is time-sensitive and requires an immediate action. These most often evolve as the result of breaking news/science and are called to the ACC's attention through the Communications Department. They generally respond to new clinical information that requires clarification or interpretation of current policy. Clinical Alerts should not be confused with a Guideline Focused Update, which is initiated by the ACC/American Heart Association (AHA) Task Force on Practice Guidelines as part of its biannual review of new evidence. Clinical Alerts are published in JACC.
Competence and Training Statements
The ACC develops competencies to cover the entire career spectrum of a cardiologist, from core cardiovascular training to advanced cardiovascular training and throughout practice. These competencies – both clinical and nonclinical – define the knowledge, skills, and behaviors that physicians, patients, the public, and accrediting bodies can reasonably expect clinical cardiologists in training to achieve and those in practice to maintain or enhance throughout the span of their career. ACC's competencies are developed using the 6 ACGME/ABMS competency domains that lead to the overarching Entrustable Professional Activities (EPAs) for cardiology that were developed and approved by ACC. Each competency and training statement contains examples of assessment tools that can be used to obtain objective evaluation of competence and needs assessment. These competencies represent official ACC policy and are published in JACC and other journals as appropriate. These documents fall under the purview of the ACC Competency Management Committee. For more information, please visit the competencies webpage here.
The ACC recognizes the importance of refining the lexicon used to describe the process and outcomes of clinical care, whether in randomized trials, observational studies, registries, or quality-improvement initiatives. Broad professional agreement on a common vocabulary with common definitions will facilitate cross-study comparisons or, when advantageous, combining of data across studies and will improve the assessment of any project's generalizability to clinical practice. Under the purview of the ACC/AHA Task Force on Clinical Data Standards, the ACC and AHA have undertaken the development and publication of clinical data standards, sets of standardized data elements and corresponding definitions that can be used in a variety of data collection efforts for a range of cardiovascular conditions. In addition to the expertise of the members of the ACC/AHA Task Force on Clinical Data Standards and related writing committees, current scientific evidence, clinical trials, and national registries, provide the foundation for the selection and definition of data elements. Data Standards are published in JACC.
Expert Consensus Documents
Expert Consensus Documents (ECDs) are intended to inform practitioners, payers, and other interested parties of the opinion of the ACC concerning evolving areas of clinical practice and/or technologies that are widely available or new to the practice community. These documents are evidence-based whenever possible but tend to be shorter than guidelines and developed around a topic that is more narrowly focused, that is new or emerging, and for which a smaller body of evidence is available. Since 2016, the ACC is no longer developing ECD's. This document type has been replaced by Expert Consensus Decision Pathways and Expert Consensus Systems of Care Documents (defined below).
Expert Consensus Decision Pathways (ECDPs) are intended to provide guidance for clinicians in areas where evidence may be limited, new and evolving, or lack sufficient data to fully inform clinical decision making. They are designed to complement the guidelines and bridge the gaps in clinical guidance that remain with the goal of developing clinical policy based on expert opinion in areas which important clinical decisions are not adequately addressed by the available existing trials. In some cases, topics covered by ECDPs will be addressed subsequently by ACC/AHA guidelines as the evidence base evolves. The writing groups are charged with developing algorithms and/or checklists that are more actionable and can be implemented into tools or apps to accelerate the use of these documents at point of care. Decision Pathways are not intended to provide a single correct answer, but to encourage clinicians to ask certain questions and consider important factors as they come to their own decision on a treatment plan for their patients. There may be multiple pathways that can be taken for treatment decisions and the goal is to help clinicians make a more informed decision. ECDPs are official ACC policy and are published in JACC.
Expert Consensus Systems of Care Documents (ECSOCDs) are intended to summarize the position of the ACC and partnering societies on the availability, delivery, organization and quality of cardiovascular care with the intention of establishing appropriate benchmarks. With the rapid evolution and dissemination of new technologies for treatment of patients with cardiovascular disease, there is an imperative for the practicing community to work together to identify the provider, institutional and systems-based standards for the delivery of high-quality care, in the spirit of optimizing the balance between access to services and quality outcomes. Wherever feasible, recommendations are evidence based. ECSOCDs are official ACC policy and are published in JACC.
The ACC Solution Set Oversight Committee oversees topic selection, writing committee selection, content development, and peer review for the Expert Consensus Decision Pathways and Expert Consensus Systems of Care Documents.
Health Policy Statements
Health Policy Statements generally promote or advocate the ACC's approach to health care policies and programs (e.g., pay for performance, retrospective review). Health Policy Statements are not intended to offer clinical guidance for treating patients, though periodically they focus on clinical topics. These statements are official ACC policy and are published in JACC.
The development of physician-level Performance Measures for important cardiovascular diseases and procedures is intended to promote the implementation of evidence-based guidelines. The intent of these measures is to provide practitioners with an opportunity to measure the quality of care for cardiovascular patients and to identify areas for further improvement. While these measures are based on and directly promote the use of ACC/AHA Practice Guidelines, it is important to note that they are not practice guidelines. Rather, they are specific measures that are indicative of quality, evidence-based care. As state and federal level efforts to measure quality and publicly report outcomes continue to expand, it is important that physicians be involved in every step of the process. As such, the ACC, through the ACC/AHA Task Force on Performance Measures, will continue to ensure that cardiovascular specialists play a central and guiding role in defining and measuring quality of care. ACC/AHA Performance Measures are published in JACC and Circulation.
Clinical Practice Guidelines are developed through a rigorous methodological approach that mandates the review and consideration of the available medical literature. Practice Guidelines define the role of specific diagnostic and therapeutic modalities, including noninvasive and invasive procedures, in the diagnosis and management of patients with various cardiovascular diseases. These evidence-based guidelines are intended to assist physicians in clinical decision making by describing a range of generally acceptable approaches for the diagnosis, management, or prevention of specific diseases or conditions. They attempt to define practices that meet the needs of most patients in most circumstances by categorizing the recommendations into a classification system. The development of Practice Guidelines is the domain of the ACC/AHA Task Force on Practice Guidelines. Practice Guidelines are published in JACC and Circulation.
Consensus Conference Reports: Consensus conferences are designed to facilitate consideration of significant and timely issues regarding the practice of cardiovascular medicine and matters affecting patient care, research, and training for which data are incomplete. Appropriate organizations other than the ACC are invited to send representatives to participate in the process. These may include physicians and health care specialists as well as representatives from industry, government, foundations, and the public sector. A report is published to highlight recommendations, along with dissenting opinion, if appropriate. Consensus Conference Reports generally evolve as conference proceedings. They include a disclaimer that the recommendations in the report are those of the conference participants and do not necessarily reflect the official position of the ACC. Consensus Conference Reports are published in JACC.
Survey and Data Reports: Survey and Data Reports are developed by an ACC Committee for the sole purpose of presenting data and/or scientific research evolving from a Committee initiative. The articles undergo a modified peer review process, including the groups that sponsored the articles, and are published in JACC. The articles represent the views of the writers and carry the caveat that the findings and conclusions in the report are those of the writing committee and do not necessarily reflect the official position of the ACC.