Sanjay Divakaran1,2, Avinainder Singh3, Ersilia M DeFilippis4, Timothy W Churchill5, Sarah Cuddy1, Yin Ge1, Ivan K Ip6, Wunan Zhou1, Hicham Skali1,2, Viviany R Taqueti1, Sharmila Dorbala1, James Spalding6, Yanqing Xu6, Ramin Khorasani7, Marcelo F Di Carli1,2, Maria A Yialamas8, Ron Blankstein9,10. 1. Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. 2. Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. 3. Department of Medicine, Yale University School of Medicine, New Haven, CT, USA. 4. Division of Cardiology, Department of Medicine, New York Presbyterian-Columbia University Irving Medical Center, New York, NY, USA. 5. Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. 6. Astellas Pharma Global Development, Inc, Northbrook, IL, USA. 7. Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. 8. Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. 9. Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. rblankstein@bwh.harvard.edu. 10. Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. rblankstein@bwh.harvard.edu.
Abstract
BACKGROUND: An upcoming national mandate will require consultation of appropriate use criteria (AUC) through a clinical decision support mechanism (CDSM) for advanced imaging. We aimed to evaluate our current ability to ascertain test appropriateness. METHODS: We prospectively collected data on 288 consecutive stress tests and coronary computed tomography angiography studies for medical inpatients. Study appropriateness was determined independently by two physicians using the 2013 Multimodality AUC. RESULTS: The median age of the study population was 66 years [interquartile range (IQR) 56, 75], 40.8% were female, and 52.8% had a history of coronary artery disease. Review of the electronic health record (EHR) alone was sufficient to deem appropriateness for 87.2% of cases. The most common reason it was insufficient was inability to determine if the patient could exercise (59.5%). After reviewing the EHR and pilot CDSM data together, appropriateness could be determined for 95.8% of the cases. The most common reason appropriateness could not be determined was that the exam indication was not addressed by an AUC criterion (83.3%). CONCLUSION: In preparing for the mandate, it will be important for future CDSM to obtain information on the patient's ability to exercise and for future AUC to include additional indications that are not currently addressed.
BACKGROUND: An upcoming national mandate will require consultation of appropriate use criteria (AUC) through a clinical decision support mechanism (CDSM) for advanced imaging. We aimed to evaluate our current ability to ascertain test appropriateness. METHODS: We prospectively collected data on 288 consecutive stress tests and coronary computed tomography angiography studies for medical inpatients. Study appropriateness was determined independently by two physicians using the 2013 Multimodality AUC. RESULTS: The median age of the study population was 66 years [interquartile range (IQR) 56, 75], 40.8% were female, and 52.8% had a history of coronary artery disease. Review of the electronic health record (EHR) alone was sufficient to deem appropriateness for 87.2% of cases. The most common reason it was insufficient was inability to determine if the patient could exercise (59.5%). After reviewing the EHR and pilot CDSM data together, appropriateness could be determined for 95.8% of the cases. The most common reason appropriateness could not be determined was that the exam indication was not addressed by an AUC criterion (83.3%). CONCLUSION: In preparing for the mandate, it will be important for future CDSM to obtain information on the patient's ability to exercise and for future AUC to include additional indications that are not currently addressed.
Authors: Meagan K Murphy; Thomas J Brady; Khurram Nasir; G Scott Gazelle; Fabian Bamberg; Quynh A Truong; Wilfred S Mamuya; Suhny Abbara; Thomas H Lee; Ron Blankstein Journal: J Nucl Cardiol Date: 2010-06-15 Impact factor: 5.952
Authors: Siqin Ye; LeRoy E Rabbani; Christopher R Kelly; Maureen R Kelly; Matthew Lewis; Yehuda Paz; Clara L Peck; Shaline Rao; Sabahat Bokhari; Shepard D Weiner; Andrew J Einstein Journal: Circ Cardiovasc Qual Outcomes Date: 2015-01-06
Authors: Su Min Chang; Faisal Nabi; Jiaqiong Xu; Craig M Pratt; Angela C Mahmarian; Maria E Frias; John J Mahmarian Journal: JACC Cardiovasc Imaging Date: 2015-02
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