R Sacha Bhatia1, Noah Ivers2, Cindy X Yin3, Dorothy Myers4, Gillian Nesbitt5, Jeremy Edwards6, Kibar Yared7, Rishi Wadhera8, Justina C Wu8, Brian Wong9, Mark Hansen9, Adina Weinerman9, Steven Shadowitz9, Amer Johri10, Michael Farkouh11, Paaladinesh Thavendiranathan12, Jacob A Udell2, Sherryn Rambihar3, Chi-Ming Chow6, Judith Hall5, Kevin E Thorpe13, Harry Rakowski12, Rory B Weiner14. 1. Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada; Peter Munk Cardiac Centre of the University Health Network, University of Toronto, Toronto, Ontario, Canada. 2. Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada; Department of Family and Community Medicine, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada; Cardiovascular Division, Brigham and Women's Hospital, Boston, MA. 3. Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada. 4. Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Canada. 5. Cardiology Division, Mount Sinai Hospital, Toronto, Ontario, Canada. 6. Echocardiogram and Vascular Lab, St Michael's Hospital, Toronto, Ontario, Canada. 7. The Scarborough Hospital, Toronto, Ontario, Canada. 8. Cardiovascular Division, Brigham and Women's Hospital, Boston, MA. 9. Sunnybrook Hospital, Toronto, Ontario, Canada. 10. Queen's University, Kingston, Ontario, Canada. 11. Peter Munk Cardiac Centre of the University Health Network, University of Toronto, Toronto, Ontario, Canada; Cardiology Division, Mount Sinai Hospital, Toronto, Ontario, Canada. 12. Peter Munk Cardiac Centre of the University Health Network, University of Toronto, Toronto, Ontario, Canada. 13. Cardiology Division, Mount Sinai Hospital, Toronto, Ontario, Canada; Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Canada. 14. Cardiology Division, Massachusetts General Hospital, Boston, MA.
Abstract
BACKGROUND: Appropriate use criteria (AUC) for transthoracic echocardiography (TTE) were developed to address concerns regarding inappropriate use of TTE. A previous pilot study suggests that an educational and feedback intervention can reduce inappropriate TTEs ordered by physicians in training. It is unknown if this type of intervention will be effective when targeted at attending level physicians in a variety of clinical settings. AIMS: The aim of this international, multicenter study is to evaluate the hypothesis that an AUC-based educational and feedback intervention will reduce the proportion of inappropriate echocardiograms ordered by attending physicians in the ambulatory environment. METHODS: In an ongoing multicentered, investigator-blinded, randomized controlled trial across Canada and the United States, cardiologists and primary care physicians practicing in the ambulatory setting will be enrolled. The intervention arm will receive (1) a lecture outlining the AUC and most recent available evidence highlighting appropriate use of TTE, (2) access to the American Society of Echocardiography mobile phone app, and (3) individualized feedback reports e-mailed monthly summarizing TTE ordering behavior including information on inappropriate TTEs and brief explanations of the inappropriate designation. The control group will receive no education on TTE appropriate use and order TTEs as usual practice. CONCLUSIONS: The Echo WISELY (Will Inappropriate Scenarios for Echocardiography Lessen Significantly in an education RCT) study is the first multicenter randomized trial of an AUC-based educational intervention. The study will examine whether an education and feedback intervention will reduce the rate of outpatient inappropriate TTEs ordered by attending level cardiologists and primary care physicians (www.clinicaltrials.gov identifier NCT02038101).
RCT Entities:
BACKGROUND: Appropriate use criteria (AUC) for transthoracic echocardiography (TTE) were developed to address concerns regarding inappropriate use of TTE. A previous pilot study suggests that an educational and feedback intervention can reduce inappropriate TTEs ordered by physicians in training. It is unknown if this type of intervention will be effective when targeted at attending level physicians in a variety of clinical settings. AIMS: The aim of this international, multicenter study is to evaluate the hypothesis that an AUC-based educational and feedback intervention will reduce the proportion of inappropriate echocardiograms ordered by attending physicians in the ambulatory environment. METHODS: In an ongoing multicentered, investigator-blinded, randomized controlled trial across Canada and the United States, cardiologists and primary care physicians practicing in the ambulatory setting will be enrolled. The intervention arm will receive (1) a lecture outlining the AUC and most recent available evidence highlighting appropriate use of TTE, (2) access to the American Society of Echocardiography mobile phone app, and (3) individualized feedback reports e-mailed monthly summarizing TTE ordering behavior including information on inappropriate TTEs and brief explanations of the inappropriate designation. The control group will receive no education on TTE appropriate use and order TTEs as usual practice. CONCLUSIONS: The Echo WISELY (Will Inappropriate Scenarios for Echocardiography Lessen Significantly in an education RCT) study is the first multicenter randomized trial of an AUC-based educational intervention. The study will examine whether an education and feedback intervention will reduce the rate of outpatientinappropriate TTEs ordered by attending level cardiologists and primary care physicians (www.clinicaltrials.gov identifier NCT02038101).
Authors: Patrick M Kozak; Silas P Trumbo; Bradley W Christensen; David L Leverenz; Matthew S Shotwell; Adam J Kingeter Journal: Int J Cardiovasc Imaging Date: 2019-03-08 Impact factor: 2.357
Authors: Tharmegan Tharmaratnam; Zachary Bouck; Atul Sivaswamy; Harindra C Wijeysundera; Cherry Chu; Cindy X Yin; Gillian C Nesbitt; Jeremy Edwards; Kibar Yared; Brian Wong; Adina Weinerman; Paaladinesh Thavendiranathan; Harry Rakowski; Paul Dorian; Geoff Anderson; Peter C Austin; David M Dudzinski; Dennis T Ko; Rory B Weiner; R Sacha Bhatia Journal: J Am Heart Assoc Date: 2019-12-24 Impact factor: 5.501
Authors: Steven Promislow; Joseph G Abunassar; Behnam Banihashemi; Benjamin J Chow; Girish Dwivedi; Kasra Maftoon; Ian G Burwash Journal: Cardiovasc Ultrasound Date: 2016-08-15 Impact factor: 2.062