Abstract 15576: Implementation of a Knowledge Translation and Education Tool to Improve Appropriate Use of Stress Echocardiography at a Large Academic Medical Center in a Public Funded Healthcare System
Introduction: Previous retrospective studies have suggested that Appropriate Use of Stress Echocardiograms (SE) is sub-optimal, but there have not been effective interventions developed to improve appropriate use of SE.
Methods: We conducted a prospective, pre (Jul 1 - Oct 15 2013) and post (Mar 1-May 31 2014) time series analysis of an educational intervention that included the development and implementation of a new ordering requisition that integrated Appropriate Use Criteria (AUC) for SE within it.
Results: During the control period, 221 consecutive were evaluated using the 2011 AUC and 98% were classifiable. Overall the inappropriate rate of classifiable studies was 32%, while the appropriate rate was 64% and uncertain rate 4%. During the intervention period, 156 studies were evaluated and 98% were classifiable. Implementation of the KT tool and educational intervention resulted in an increase in the appropriateness rate to 76% (p=0.016) and a reduction in the inappropriate rate to 19% (p=0.003) of all classifiable studies. The largest physician group responsible for inappropriate ordering of SE was vascular surgery (61% of all studies ordered were inappropriate) followed by family practice (38%), and cardiology (16%). The uncertain rate did not significantly change (6%; p=0.47). The positive rate was 20% for appropriate studies and 10% for inappropriate SEs.
Conclusion: Implementation of an integrated educational intervention involving a new requisition tool that integrated AUC resulted in a significantly reduced inappropriate rate of SE and a higher appropriate rate in a large academic medical center. Further study is required to determine whether these results are generalizable to different practice environments.
Author Disclosures: K. Levitt: None. C. Chow: None. J. Edwards: None. S. Bhatia: None.
- © 2014 by American Heart Association, Inc.