16 Aug Fewer Inappropriate Echocardiograms Ordered When Physician Education Implemented

MedicalResearch.com Interview with:

Dr. Rory Brett Weiner

Rory Brett Weiner, MD
Assistant Professor of Medicine
Harvard Medical School

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The increased use of noninvasive cardiac imaging and Medicare spending in the late 1990s and early 2000s has led to several measures to help optimize the use of cardiac imaging. One such effort has been the Appropriate Use Criteria (AUC) put forth by the American College of Cardiology Foundation. The AUC for echocardiography have been useful to characterize practice patterns and more recently been used as a tool to try to improve ordering of echocardiograms. Our research group previously conducted a randomized study of physicians-in-training (cardiovascular medicine fellows) and showed that an AUC based educational and feedback intervention reduced the rate of rarely appropriate transthoracic echocardiograms (TTEs).

The current study represents the first randomized controlled trial of an AUC education and feedback intervention attending level cardiologists. In this study, the intervention group (which in addition to education received monthly feedback emails regarding their individual TTE ordering) ordered fewer rarely appropriate TTEs than the control group. The most common reasons for rarely appropriate TTEs in this study were ‘surveillance’ echocardiograms, referring to those in patients with known cardiac disease but no change in their clinical status.

MedicalResearch.com: What should readers take away from your report?

Response: Our study suggests that education and feedback may be an effective method for optimizing ordering of echocardiograms by attending cardiologists. This represents a strategy that preserves physician autonomy in clinical decision-making. Additionally, identification of the most common rarely appropriate clinical scenarios in a given practice situation may help to focus educational efforts.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: This type of AUC based educational and feedback intervention requires study with other types of healthcare providers and in other non-academic settings. A multicenter trial addressing these issues is currently underway.

Additionally, the impact of this type of intervention from a healthcare costs and patient outcomes is needed.

Citation:

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Last Updated on August 16, 2016 by Marie Benz MD FAAD