Evolution of evaluation criteria in the College of American Pathologists Surveys

This review of the evolution of evaluation criteria in the College of American Pathologists Survey and of theoretical grounds proposed for evaluation criteria explores the complex nature of the evaluation process. Survey professionals balance multiple variables to seek relevant and meaningful evaluations. These include the state of the art, the reliability of target values, the nature of available control materials, the perceived medical "nonusefulness" of the extremes of performance (good or poor), this extent of laboratory services provided, and the availability of scientific data and theory by which clinically relevant criteria of medical usefulness may be established. The evaluation process has consistently sought peer concensus, to stimulate improvement in state of the art, to increase medical usefulness, and to monitor the state of the art. Recent factors that are likely to promote change from peer group evaluation to fixed criteria evaluation are the high degree of proficiency in the state of the art for many analytes, accurate target values, increased knowledge of biologic variation, and the availability of statistical modeling techniques simulating biologic and diagnostic processes as well as analytic processes.