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

Claudia I. Vidal, Eric A. Armbrect, Aleodor A. Andea, Angela K. Bohlke, Nneka I. Comfere, Sarah R. Hughes, Jinah Kim, Jessica A. Kozel, Jason B. Lee, Konstantinos Linos, Brandon R. Litzner, Tricia A. Missall, Roberto A. Novoa, Uma Sundram, Brian L. Swick, Maria Yadira Hurley, Murad Alam, Zsolt Argenyi, Lyn M. Duncan, Dirk M. ElstonPatrick O. Emanuel, Tammie Ferringer, Maxwell A Fung, Gregory A. Hosler, Alexander J. Lazar, Lori Lowe, Jose A. Plaza, Victor G. Prieto, June K. Robinson, Andras Schaffer, Antonio Subtil, Wei Lien Wang

Research output: Contribution to journalArticle

7 Scopus citations

Abstract

Background: Appropriate use criteria (AUC) provide physicians guidance in test selection, and can affect health care delivery, reimbursement policy and physician decision-making. Objectives: The American Society of Dermatopathology, with input from the American Academy of Dermatology and the College of American Pathologists, sought to develop AUC in dermatopathology. Methods: The RAND/UCLA appropriateness methodology, which combines evidence-based medicine, clinical experience and expert judgment, was used to develop AUC in dermatopathology. Results: With 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.”. Limitations: The methodology requires a focus on appropriateness without comparison between tests and irrespective of cost. Conclusions: The 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 appropriateness—AUC 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.

Original languageEnglish (US)
Pages (from-to)563-580
Number of pages18
JournalJournal of Cutaneous Pathology
Volume45
Issue number8
DOIs
StatePublished - Aug 1 2018

Keywords

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

ASJC Scopus subject areas

  • Pathology and Forensic Medicine
  • Histology
  • Dermatology

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    Vidal, C. I., Armbrect, E. A., Andea, A. A., Bohlke, A. K., Comfere, N. I., Hughes, S. R., Kim, J., Kozel, J. A., Lee, J. B., Linos, K., Litzner, B. R., Missall, T. A., Novoa, R. A., Sundram, U., Swick, B. L., Hurley, M. Y., Alam, M., Argenyi, Z., Duncan, L. M., ... Wang, W. L. (2018). Appropriate use criteria in dermatopathology: Initial recommendations from the American Society of Dermatopathology. Journal of Cutaneous Pathology, 45(8), 563-580. https://doi.org/10.1111/cup.13142