International Circulation: As a member of the ACC task force， we want to ask how are the Appropriate Use Criteria (AUC) different from a guideline?
　　Dr. Steven Bailey: That has been one of the most important questions. The question revolves around how you use guidelines. The analogy would be a sign post. Though there be a speed limit of 70 mph on a freeway， there may be times when it is appropriate to only drive 55 mph， such as when it is raining， there is traffic， or a if it is a difficult stretch of the road. However， if I drove according to the guidelines at 70 mph， then I would not be driving correctly. Experience needs to be part of the decision process in addition to guidelines. The AUC allow us to take scientifically developed data and make decisions about the right way to treat patients and under what circumstances.
　　《国际循环》：您是ACC特别工作组成员，请问合理使用标准（Appropriate Use Criteria ，AUC）与指南有何不同？
　　Dr. Steven Bailey：这是最为重要的问题。这个问题的答案在于你如何使用指南。我们可以将其比作一个信号标志。虽然高速公路限速最低70 mph，但有时如下雨、交通堵塞或路况不佳时可能驾车速度55 mph更为合理。所以，如果仅根据指南驾车速度保持70 mph，那么有时是违背实际情况的。实践是在指南之外制定决策的一部分。AUC允许我们在不同情况下，利用科学建立起来的数据做出治疗患者的正确决策。
　　International Circulation: Does this imply that there is more expert opinion in the AUC than in the guidelines?
　　Dr. Bailey: Exactly right. Guidelines involve many individuals， individuals who have great expertise in that particular area. This is important for delivering the best information. The AUC are specifically designed to have a much broader group. They are done differently. With guidelines， you meet， you discuss， and it is done but the AUC are arranged by a group of diverse individuals， often with diverse backgrounds who develop case scenarios. Guidelines take data and reduce that to sign posts. AUC takes clinical practice and the guidelines to come up with patient-centered information. Those scenarios are then given from an expert panel to a technical panel. The technical panel is presented this information with case scenarios and their job is to go through， analyze those cases， and determine what is appropriate. There are a lot of conditions about the patient that may change how one feels about the case and introduce uncertainty. In other groups， it is pretty clear. Would you do PCI on a patient without symptoms and has a branched artery stenosis? You would not. That is inappropriate. That technical panel meets after that first rating period. They sit， in person， discuss， and then go back and rate it a second time. Now we have the ability to consider the information as it is related to groups of patients over time. It is important to understand the AUC are not designed to tell me how to treat an individual patient. It is designed to allow us to consider how patients groups or populations are taken care of.
　　《国际循环》：这是否意味着AUC中有比指南中更多的专家意见？
　　Dr. Steven Bailey：非常正确。指南中包含了在一定领域内的重要专家们的意见，这对于传递最佳信息至关重要。AUC的专门设计涵盖了更广的范围，其完成方式是不同的。指南的制定过程中，专家们聚集一堂进行讨论，最终制定一部指南；而AUC是由一组具有不同背景的专家完成，就像完成一部病例脚本。指南利用研究资料，精简成一个标杆信号标志；AUC则利用临床实践经验和指南，传递出以患者为中心的信息。专家工作组将这种脚本移交给技术工作组，后者的任务是审核这些病例脚本，分析其中的病例，最终决定哪些是适用的。在许多情况下，可能一组专家会改变对某病例的看法，认为其具有不确定性；而另一组则认为非常明确。你是否会对1例无症状的分支血管狭窄患者施行PCI？你不会，那是不合理的。技术工作组在最初评判后会召集会议，坐下来进行个人间的讨论，回到上述问题再次进行表决。重要的是要理解：AUC不是被设计用来告诉我们如何治疗1个患者，而是使我们明确一类患者或人群应接受何种治疗。