Kevin Levitt1, Jeremy Edwards2, Chi-Ming Chow2, R Sacha Bhatia3. 1. Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Toronto, Ontario, Canada; St. Michael's Hospital, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada. 2. St. Michael's Hospital, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada. 3. Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada; Peter Munk Cardiac Centre of the University Health Network, Toronto General Hospital, Toronto, Ontario, Canada. Electronic address: sacha.r.bhatia@wchospital.ca.
Abstract
BACKGROUND: Despite previous studies demonstrating suboptimal appropriate use of stress echocardiography (SE), few interventions have been demonstrated to improve its appropriate use. The aim of this study was to develop a novel mechanism to improve the appropriateness of SE by implementing a point-of-care decision support tool and ordering requisition coupled with an educational strategy. METHODS: A prospective pre- and postintervention analysis was conducted. The intervention included education and the development and implementation of novel ordering requisition coupled with a decision support tool that integrated appropriate use criteria (AUC) for SE. RESULTS: In the baseline period, 256 consecutive stress echocardiographic studies were evaluated, and 97% were classifiable by the 2011 AUC. During the intervention period, 159 studies were evaluated (98% classifiable). The intervention resulted in an increase in the appropriate proportion from 65% to 76% and a reduction in the rarely appropriate proportion from 31% to 19% (P = .017). After adjustment for physician specialty, the postintervention period had lower odds of rarely appropriate testing (0.54; 95% CI, 0.3-0.95; P = .04). Cardiology had significant lower odds of rarely appropriate testing (0.23; 95% CI, 0.11-0.50; P < .001) compared with family practice (the reference standard). Vascular surgery had the highest odds (5.76; 95% CI, 2.18-21.52; P = .002) of rarely appropriate testing. CONCLUSION: AUC have not previously been applied to SE in a single-payer, publicly funded health system. The development of an educational intervention involving a new requisition and decision support tool that integrated AUC resulted in a significantly reduced proportion of rarely appropriate SE. Cardiologists ordered the highest proportion of appropriate SE. Further study is needed to determine the generalizability of the results.
BACKGROUND: Despite previous studies demonstrating suboptimal appropriate use of stress echocardiography (SE), few interventions have been demonstrated to improve its appropriate use. The aim of this study was to develop a novel mechanism to improve the appropriateness of SE by implementing a point-of-care decision support tool and ordering requisition coupled with an educational strategy. METHODS: A prospective pre- and postintervention analysis was conducted. The intervention included education and the development and implementation of novel ordering requisition coupled with a decision support tool that integrated appropriate use criteria (AUC) for SE. RESULTS: In the baseline period, 256 consecutive stress echocardiographic studies were evaluated, and 97% were classifiable by the 2011 AUC. During the intervention period, 159 studies were evaluated (98% classifiable). The intervention resulted in an increase in the appropriate proportion from 65% to 76% and a reduction in the rarely appropriate proportion from 31% to 19% (P = .017). After adjustment for physician specialty, the postintervention period had lower odds of rarely appropriate testing (0.54; 95% CI, 0.3-0.95; P = .04). Cardiology had significant lower odds of rarely appropriate testing (0.23; 95% CI, 0.11-0.50; P < .001) compared with family practice (the reference standard). Vascular surgery had the highest odds (5.76; 95% CI, 2.18-21.52; P = .002) of rarely appropriate testing. CONCLUSION: AUC have not previously been applied to SE in a single-payer, publicly funded health system. The development of an educational intervention involving a new requisition and decision support tool that integrated AUC resulted in a significantly reduced proportion of rarely appropriate SE. Cardiologists ordered the highest proportion of appropriate SE. Further study is needed to determine the generalizability of the results.
Authors: Weihan Chen; David T Saxon; Michael P Henry; John R Herald; Rob Holleman; Debbie Zawol; Stacy Sivils; Mohamad A Kenaan; Theodore J Kolias; Hitinder S Gurm; Nicole M Bhave Journal: J Am Soc Echocardiogr Date: 2020-11-01 Impact factor: 5.251
Authors: B J Bouma; R Riezenbos; A J Voogel; M H Veldhorst; W Jaarsma; J Hrudova; B Cernohorsky; S Chamuleau; R B A van den Brink; R Breedveld; C Reichert; O Kamp; R Braam; J P van Melle Journal: Neth Heart J Date: 2017-05 Impact factor: 2.380
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