Abstract 16861: Reduction in Inappropriate Utilization of Myocardial Perfusion SPECT, Stress Echocardiography, and Coronary CT Angiography Using a Point-of-Order Automated Decision Support Tool: The Prospective Multicenter ENCOURAGE study
Background. The appropriate use rates for myocardial perfusion SPECT (MPS), stress echocardiography (STE) and coronary CT angiography (CCTA) in the community are unknown.
Methods. We prospectively collected American College of Cardiology appropriate use criteria (AUC) ratings on consecutive MPS, STE and CCTA studies among single specialty cardiology practices in one large metro area that submitted claims to United Health Care. Physician groups used online appropriate use decision support tools for determination of appropriateness.
Results. 4 physician groups comprised of 101 cardiologists rated indications for 612 patients over 8 months (43±25 years, 35% female, 18% diabetic, 40% prior CAD). Imaging studies comprised 431 (70%) MPS, 152 (25%) STE and 29 (5%) CCTA. On average, it took 133+322 seconds to obtain an appropriate use rating using the calculator. Appropriate studies constituted 56%, 47%, and 52% of all MPS, STE and CCTA respectively, while indications not covered by AUC guidelines constituted 7%, 18% and 17% respectively. There were no significant differences in the proportions of appropriate, uncertain, inappropriate and non-addressed indications by MPS, STE or CCTA (p=0.16). There was a secular trend towards decreased inappropriate studies over time (23% in 1st quarter vs 11% in last (4th) quarter, p = 0.002)
Conclusion. In a consecutive cohort of imaging studies in a large metro area, the distribution of appropriateness ratings does not differ significantly between modalities. An appropriate use decision support tool reduces inappropriate testing over time.
- © 2011 by American Heart Association, Inc.