Two areas in which the writing committee tried to advance process measures were in patient selection measures and patient education/shared decision-making measures. Given the novelty of these topics, these are discussed in greater detail in the subsequent sections. 4.1.1. Patient Selection Measures As with many procedures, evaluating patient selection and determining appropriateness is a crucial rst step in ensuring high-quality clinical care. Nevertheless, this has not been done previously in performance measures for procedures. Ideally, this evaluation would revolve around both patients undergoing PCI and patients who are de- ferred from the procedure, to ensure that underutilization of potentially bene cial treatments is not occurring (17). Moreover, the indication (or reason) for the revasculariza- tion is attributable to several providers, including the referring physician and interventional cardiologist, as well as their discussions with the consenting patient. To date, the ACCF/SCAI/STS/AATS/AHA/ASNC/ HFSA/SCCT 2012 Appropriate Use Criteria for Coronary Table 4. ACC/AHA Task Force on Performance Measures: Attributes for Performance Measures 1. Evidence Based High-impact area that is useful in improving patient outcomes a) For structural measures, the structure should be closely linked to a meaningful process of care that in turn is linked to a meaningful patient outcome. b) For process measures, the scientific basis for the measure should be well established, and the process should be closely linked to a meaningful patient outcome. c) For outcome measures, the outcome should be clinically meaningful. If appropriate, performance measures based on outcomes should adjust for relevant clinical characteristics through the use of appropriate meth- odology and high-quality data sources. 2. Measure Selection Measure de nition a) The patient group to whom the measure applies (denominator) and the patient group for whom conformance is achieved (numerator) are clearly defined and clinically meaningful. 