Abstract 3897: Initial Effect of Guideline Implementation on Utilization of Myocardial Stress Perfusion Imaging
Introduction: Guidelines for cardiac testing have been developed but their potential impact on test utilization has not been assessed. We examined the initial impact of guideline-driven precertification of radionuclide stress testing on test utilization.
Methods: An algorithm for precertification of nuclear stress tests was developed by Care Core Cardiology Management, based on ACC/AHA/ASNC practice guidelines and appropriateness criteria for clinical use of cardiac radionuclide imaging. From 2/03/06–4/30/06 the algorithm was used for test precertification in a population of 829,360 covered lives with commercial (95.1%, mean age 33.2 yrs, 50.9% female) or Medicare insurance( 4.1%, mean age 73.3 yrs, 56.9% female). Requests were submitted by practicing physicians caring for each patient. We evaluated rates per 1000 insured for requests, approvals, denials of requests, withdrawals and denials reversed and upheld, comparing them to those in a matched time period(2/05–4/05) one year prior to the test period
Results: Patients in whom nuclear stress was requested were older and more often male(age 54±10 yrs, 59% male commercial; 74±7 yrs, 54% male Medicare).The change in test approvals(See Table⇓) was −24.8% versus the matched period while annual growth in testing from 2004–2005 had been +25%. Requests fell from 39.60/1000 in 3/05–4/05 to 37.15/1000 during the two month period after introduction of the algorithm (3/06–4/06, p=0.0007), suggestive of a “sentinel effect.”
Conclusions: In a large population of over 800,000 individuals with high test utilization, introduction of guideline-based algorithms was associated with a significant and marked fall in approvals and utilization of nuclear stress testing and low rates of denial appeals and reversals. While the effect on long-term clinical outcomes remains to be determined, a guideline-driven nuclear stress test algorithm for test utilization appears to offer substantial savings in health care costs.