BACKGROUND: Inappropriate use of myocardial perfusion imaging (MPI) may vary depending on the training, specialty, or practice location of the clinician. METHODS: We conducted a cross-sectional investigation of consecutive patients who underwent MPI at our Veterans Affairs medical center between December 2010 and July 2011. Characteristics of the MPI ordering clinicians were extracted to investigate any associations with inappropriate use. RESULTS: 582 patients were included, 9.8% were inappropriate. No difference in inappropriate use was observed between cardiology and non-cardiology clinicians (n = 21, 9.5% vs n = 36, 10.0%, P = .83); no difference was noted between nurse practitioners/physician assistants, attending physicians, and housestaff (7.5% vs 11.2% vs 1.8%, P = .06). Comparing inpatient, emergency department and outpatient clinician groups, the difference was null (8.6% vs 6.3% vs 10.1%, P = .75). For most clinician groups, the most common inappropriate indication was an asymptomatic scenario; however, some groups were different: definite acute coronary syndrome for inpatient clinicians and low risk syncope for emergency medicine clinicians. CONCLUSIONS: Clinician groups appear to order inappropriate MPI at similar rates, regardless of their training, specialty, or practice location. Differences in the most common type of inappropriate testing suggest that interventions to reduce inappropriate use should be tailored to specific clinician types.
BACKGROUND: Inappropriate use of myocardial perfusion imaging (MPI) may vary depending on the training, specialty, or practice location of the clinician. METHODS: We conducted a cross-sectional investigation of consecutive patients who underwent MPI at our Veterans Affairs medical center between December 2010 and July 2011. Characteristics of the MPI ordering clinicians were extracted to investigate any associations with inappropriate use. RESULTS: 582 patients were included, 9.8% were inappropriate. No difference in inappropriate use was observed between cardiology and non-cardiology clinicians (n = 21, 9.5% vs n = 36, 10.0%, P = .83); no difference was noted between nurse practitioners/physician assistants, attending physicians, and housestaff (7.5% vs 11.2% vs 1.8%, P = .06). Comparing inpatient, emergency department and outpatient clinician groups, the difference was null (8.6% vs 6.3% vs 10.1%, P = .75). For most clinician groups, the most common inappropriate indication was an asymptomatic scenario; however, some groups were different: definite acute coronary syndrome for inpatient clinicians and low risk syncope for emergency medicine clinicians. CONCLUSIONS: Clinician groups appear to order inappropriate MPI at similar rates, regardless of their training, specialty, or practice location. Differences in the most common type of inappropriate testing suggest that interventions to reduce inappropriate use should be tailored to specific clinician types.
Authors: J M Grimshaw; L Shirran; R Thomas; G Mowatt; C Fraser; L Bero; R Grilli; E Harvey; A Oxman; M A O'Brien Journal: Med Care Date: 2001-08 Impact factor: 2.983
Authors: Erik von Elm; Douglas G Altman; Matthias Egger; Stuart J Pocock; Peter C Gøtzsche; Jan P Vandenbroucke Journal: PLoS Med Date: 2007-10-16 Impact factor: 11.069
Authors: David E Winchester; Andrew Kitchen; John C Brandt; Raman S Dusaj; Salim S Virani; Steven M Bradley; Leslee J Shaw; Rebecca J Beyth Journal: Clin Cardiol Date: 2015-04-13 Impact factor: 2.882
Authors: Daniel Cordiner; Mohammad Al-Ani; Xiaoming Jia; Michael Marchick; Brandon Allen; David E Winchester Journal: Coron Artery Dis Date: 2019-12 Impact factor: 1.439
Authors: Islam Y Elgendy; Ahmed Mahmoud; Jonathan J Shuster; Rami Doukky; David E Winchester Journal: J Nucl Cardiol Date: 2015-08-08 Impact factor: 5.952
Authors: Joseph A Ladapo; Saul Blecker; Michael O'Donnell; Saahil A Jumkhawala; Pamela S Douglas Journal: PLoS One Date: 2016-08-18 Impact factor: 3.240
Authors: Kristopher P Kline; Leslee Shaw; Rebecca J Beyth; Jared Plumb; Linda Nguyen; Tianyao Huo; David E Winchester Journal: BMC Health Serv Res Date: 2017-08-11 Impact factor: 2.655