Abstract 18170: The Impact of Systematic Implementation of SPECT Appropriateness Criteria on Procedures Utilization and Cost: A Prospective and Randomized Clinical Trial With One Year Follow-Up
Background: The SPECT Appropriateness Criteria (AC) has been used for the last 8 years to improve SPECT and subsequent procedure utilizations. However, there is no prospective trial data on the change of procedure volumes after systematic implementation of AC in the cardiology and primary care clinic settings on daily basis using Electronic Medical Records (EMR). MPI Optimization & Referrals (MORE) Trial is a single center, randomized and prospective study to investigate the long-term impacts of systematic implementation of AC on SPECT/subsequent invasive procedure volumes, clinical and financial outcomes.
Methods: Consecutive 10,303 outpatients with 10 physicians were randomized into a control (CG) and interventional (IG) group. All patients were assessed using EMR and SPECT AC (2009). Recommendations to refer for SPECT in the IG were made only if patients were graded as Appropriate SPECT prior to their visits. No recommendations were made to CG. SPECT use through the 5-month study period was compared to the use 5 months prior to the trial as a baseline. All patients were followed for 1 year after initial AC assessment for subsequent catheterization, cardiac events (MI and death) and financial outcomes.
Results: Compared to the baseline prior to the trial, SPECT volume had no change in CG, 64 to 68 (6%), but significantly increased in IG from 87 to 112 (29%, p < 0.01). Among patients in the IG group, there is a significant decrease in catheterization from 174 to 110 (37%) compared to 176 to 135 in CG (23%, p<0.002). No significant change in cardiac events (MI and death) between CG and IG in the 1-year follow-up. The cost is significantly decreased in the IG compared to the CG ($5,865±3,433 vs. $9,505±1,345) with the net average savings of $3,640 (38%, p< 0.001) per patient after 1 year.
Conclusion: This is the first randomized clinical trial to demonstrate that systematic implementation of SPECT AC using EMR in cardiology and primary care setting on daily basis not only increased SPECT service volume appropriately but also lead to less subsequent invasive procedure utilization and lower the entire care cost without any significant changes of adverse cardiac outcomes. Further studies with long term clinical and financial outcomes are warranted.
- © 2013 by American Heart Association, Inc.