TY - JOUR
T1 - Effect of Release of the First Pediatric Appropriate Use Criteria on Transthoracic Echocardiogram Ordering Practice
AU - Sachdeva, Ritu
AU - Douglas, Pamela S.
AU - Kelleman, Michael S.
AU - McCracken, Courtney E.
AU - Lopez, Leo
AU - Stern, Kenan W.D.
AU - Eidem, Benjamin W.
AU - Benavidez, Oscar J.
AU - Weiner, Rory B.
AU - Welch, Elizabeth
AU - Campbell, Robert M.
AU - Lai, Wyman W.
N1 - Publisher Copyright:
© 2016 Elsevier Inc.
PY - 2016/11/15
Y1 - 2016/11/15
N2 - Pediatric appropriate use criteria (AUC) were recently published for initial outpatient transthoracic echocardiography (TTE). The purpose of this study was to determine the effect of AUC publication on TTE ordering patterns of pediatric cardiologists. Data were prospectively collected on patients who had initial outpatient TTE ordered before (phase I, April to September 2014) and 3 months after (phase II, January to April 2015) AUC document publication at 6 centers. Site investigators assessed each study's indication and assigned AUC appropriateness as “appropriate” (A), “may be appropriate” (M), “rarely appropriate” (R), or “unclassifiable.” One hundred three physicians ordered 4,562 TTEs (2,655 phase I and 1,907 phase II). Overall, there was no statistically significant change in the proportion of A, M, or unclassifiable, but R decreased (12.0% to 9.6%, p = 0.01). There was significant variability among the centers in the percentage of studies for indications rated R (4.9% to 34.8%). There was no significant change in any of the appropriateness ratings at 4 centers, a decrease in R and an increase in A at 1 and a decrease in R and increase in unclassifiable at another. The first pediatric AUC document had only a small impact on physician ordering behavior for initial TTEs, including a small decrease in R. There was a significant variability in appropriateness of studies among centers. These data suggest that active educational interventions are required to substantially improve the appropriate use of pediatric TTE in the outpatient setting.
AB - Pediatric appropriate use criteria (AUC) were recently published for initial outpatient transthoracic echocardiography (TTE). The purpose of this study was to determine the effect of AUC publication on TTE ordering patterns of pediatric cardiologists. Data were prospectively collected on patients who had initial outpatient TTE ordered before (phase I, April to September 2014) and 3 months after (phase II, January to April 2015) AUC document publication at 6 centers. Site investigators assessed each study's indication and assigned AUC appropriateness as “appropriate” (A), “may be appropriate” (M), “rarely appropriate” (R), or “unclassifiable.” One hundred three physicians ordered 4,562 TTEs (2,655 phase I and 1,907 phase II). Overall, there was no statistically significant change in the proportion of A, M, or unclassifiable, but R decreased (12.0% to 9.6%, p = 0.01). There was significant variability among the centers in the percentage of studies for indications rated R (4.9% to 34.8%). There was no significant change in any of the appropriateness ratings at 4 centers, a decrease in R and an increase in A at 1 and a decrease in R and increase in unclassifiable at another. The first pediatric AUC document had only a small impact on physician ordering behavior for initial TTEs, including a small decrease in R. There was a significant variability in appropriateness of studies among centers. These data suggest that active educational interventions are required to substantially improve the appropriate use of pediatric TTE in the outpatient setting.
UR - http://www.scopus.com/inward/record.url?scp=84994142344&partnerID=8YFLogxK
U2 - 10.1016/j.amjcard.2016.08.019
DO - 10.1016/j.amjcard.2016.08.019
M3 - Article
C2 - 27639687
AN - SCOPUS:84994142344
SN - 0002-9149
VL - 118
SP - 1545
EP - 1551
JO - American Journal of Cardiology
JF - American Journal of Cardiology
IS - 10
ER -