A Multicenter Assessment of the Use of Single-Photon Emission Computed Tomography Myocardial Perfusion Imaging With Appropriateness Criteria

Robert Hendel, Manuel Cerqueira, Pamela S. Douglas, Karen C. Caruth, Joseph M. Allen, Neil C. Jensen, Wenqin Pan, Ralph Brindis, Michael Wolk

Research output: Contribution to journalArticle

124 Citations (Scopus)

Abstract

Objectives: The aim of this study was to assess the feasibility of evaluation for appropriate use of radionuclide myocardial perfusion imaging (MPI) in multiple clinical sites and to determine use patterns as well as identify areas of apparent inappropriate use. Background: Although cardiac imaging is highly valued for decision-making, the growth and expense related to these procedures has raised questions regarding overuse. The publication of appropriate use criteria (AUC), including those for MPI, were designed to provide guidance in the rational use of testing. However, limited data regarding the implementation and evaluation of AUC are available. Methods: Six diverse clinical sites enrolled consecutive patients undergoing MPI, collecting point-of-service data entered into an online form. An automated algorithm assigned a specific indication from the AUC that was classified as appropriate, uncertain, or inappropriate. Site-specific feedback was later provided to each practice on ordering patterns. Results: Of the 6,351 patients enrolled, 93% were successfully assigned an appropriateness level. Inappropriate use of MPI was found in 14.4% of patients, with a range of 4% to 22% among practices. Women and younger patients were more likely to undergo inappropriate MPI. Asymptomatic, low-risk patients accounted for 44.5% of inappropriate testing. Elimination of the 5 most common inappropriate use indications would reduce overall imaging volume by 13.2%. Inappropriate use by physicians from within the practice performing imaging was not greater than physicians outside of the practice. Educational feedback might have resulted in reduced inappropriate test ordering in 1 site. Conclusions: The tracking of appropriate use is feasible in clinical practice, with an automated system that can readily identify practice patterns and targets for educational and quality improvement initiatives. This approach might provide an alternative to utilization management.

Original languageEnglish
Pages (from-to)156-162
Number of pages7
JournalJournal of the American College of Cardiology
Volume55
Issue number2
DOIs
StatePublished - Jan 12 2010
Externally publishedYes

Fingerprint

Myocardial Perfusion Imaging
Single-Photon Emission-Computed Tomography
Physicians
Quality Improvement
Radioisotopes
Publications
Decision Making
Growth

Keywords

  • appropriateness criteria
  • diagnostic testing
  • radionuclide imaging
  • SPECT

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

A Multicenter Assessment of the Use of Single-Photon Emission Computed Tomography Myocardial Perfusion Imaging With Appropriateness Criteria. / Hendel, Robert; Cerqueira, Manuel; Douglas, Pamela S.; Caruth, Karen C.; Allen, Joseph M.; Jensen, Neil C.; Pan, Wenqin; Brindis, Ralph; Wolk, Michael.

In: Journal of the American College of Cardiology, Vol. 55, No. 2, 12.01.2010, p. 156-162.

Research output: Contribution to journalArticle

Hendel, Robert ; Cerqueira, Manuel ; Douglas, Pamela S. ; Caruth, Karen C. ; Allen, Joseph M. ; Jensen, Neil C. ; Pan, Wenqin ; Brindis, Ralph ; Wolk, Michael. / A Multicenter Assessment of the Use of Single-Photon Emission Computed Tomography Myocardial Perfusion Imaging With Appropriateness Criteria. In: Journal of the American College of Cardiology. 2010 ; Vol. 55, No. 2. pp. 156-162.
@article{97096bdc439b4d80a0b3ef6cdbd77b74,
title = "A Multicenter Assessment of the Use of Single-Photon Emission Computed Tomography Myocardial Perfusion Imaging With Appropriateness Criteria",
abstract = "Objectives: The aim of this study was to assess the feasibility of evaluation for appropriate use of radionuclide myocardial perfusion imaging (MPI) in multiple clinical sites and to determine use patterns as well as identify areas of apparent inappropriate use. Background: Although cardiac imaging is highly valued for decision-making, the growth and expense related to these procedures has raised questions regarding overuse. The publication of appropriate use criteria (AUC), including those for MPI, were designed to provide guidance in the rational use of testing. However, limited data regarding the implementation and evaluation of AUC are available. Methods: Six diverse clinical sites enrolled consecutive patients undergoing MPI, collecting point-of-service data entered into an online form. An automated algorithm assigned a specific indication from the AUC that was classified as appropriate, uncertain, or inappropriate. Site-specific feedback was later provided to each practice on ordering patterns. Results: Of the 6,351 patients enrolled, 93{\%} were successfully assigned an appropriateness level. Inappropriate use of MPI was found in 14.4{\%} of patients, with a range of 4{\%} to 22{\%} among practices. Women and younger patients were more likely to undergo inappropriate MPI. Asymptomatic, low-risk patients accounted for 44.5{\%} of inappropriate testing. Elimination of the 5 most common inappropriate use indications would reduce overall imaging volume by 13.2{\%}. Inappropriate use by physicians from within the practice performing imaging was not greater than physicians outside of the practice. Educational feedback might have resulted in reduced inappropriate test ordering in 1 site. Conclusions: The tracking of appropriate use is feasible in clinical practice, with an automated system that can readily identify practice patterns and targets for educational and quality improvement initiatives. This approach might provide an alternative to utilization management.",
keywords = "appropriateness criteria, diagnostic testing, radionuclide imaging, SPECT",
author = "Robert Hendel and Manuel Cerqueira and Douglas, {Pamela S.} and Caruth, {Karen C.} and Allen, {Joseph M.} and Jensen, {Neil C.} and Wenqin Pan and Ralph Brindis and Michael Wolk",
year = "2010",
month = "1",
day = "12",
doi = "10.1016/j.jacc.2009.11.004",
language = "English",
volume = "55",
pages = "156--162",
journal = "Journal of the American College of Cardiology",
issn = "0735-1097",
publisher = "Elsevier USA",
number = "2",

}

TY - JOUR

T1 - A Multicenter Assessment of the Use of Single-Photon Emission Computed Tomography Myocardial Perfusion Imaging With Appropriateness Criteria

AU - Hendel, Robert

AU - Cerqueira, Manuel

AU - Douglas, Pamela S.

AU - Caruth, Karen C.

AU - Allen, Joseph M.

AU - Jensen, Neil C.

AU - Pan, Wenqin

AU - Brindis, Ralph

AU - Wolk, Michael

PY - 2010/1/12

Y1 - 2010/1/12

N2 - Objectives: The aim of this study was to assess the feasibility of evaluation for appropriate use of radionuclide myocardial perfusion imaging (MPI) in multiple clinical sites and to determine use patterns as well as identify areas of apparent inappropriate use. Background: Although cardiac imaging is highly valued for decision-making, the growth and expense related to these procedures has raised questions regarding overuse. The publication of appropriate use criteria (AUC), including those for MPI, were designed to provide guidance in the rational use of testing. However, limited data regarding the implementation and evaluation of AUC are available. Methods: Six diverse clinical sites enrolled consecutive patients undergoing MPI, collecting point-of-service data entered into an online form. An automated algorithm assigned a specific indication from the AUC that was classified as appropriate, uncertain, or inappropriate. Site-specific feedback was later provided to each practice on ordering patterns. Results: Of the 6,351 patients enrolled, 93% were successfully assigned an appropriateness level. Inappropriate use of MPI was found in 14.4% of patients, with a range of 4% to 22% among practices. Women and younger patients were more likely to undergo inappropriate MPI. Asymptomatic, low-risk patients accounted for 44.5% of inappropriate testing. Elimination of the 5 most common inappropriate use indications would reduce overall imaging volume by 13.2%. Inappropriate use by physicians from within the practice performing imaging was not greater than physicians outside of the practice. Educational feedback might have resulted in reduced inappropriate test ordering in 1 site. Conclusions: The tracking of appropriate use is feasible in clinical practice, with an automated system that can readily identify practice patterns and targets for educational and quality improvement initiatives. This approach might provide an alternative to utilization management.

AB - Objectives: The aim of this study was to assess the feasibility of evaluation for appropriate use of radionuclide myocardial perfusion imaging (MPI) in multiple clinical sites and to determine use patterns as well as identify areas of apparent inappropriate use. Background: Although cardiac imaging is highly valued for decision-making, the growth and expense related to these procedures has raised questions regarding overuse. The publication of appropriate use criteria (AUC), including those for MPI, were designed to provide guidance in the rational use of testing. However, limited data regarding the implementation and evaluation of AUC are available. Methods: Six diverse clinical sites enrolled consecutive patients undergoing MPI, collecting point-of-service data entered into an online form. An automated algorithm assigned a specific indication from the AUC that was classified as appropriate, uncertain, or inappropriate. Site-specific feedback was later provided to each practice on ordering patterns. Results: Of the 6,351 patients enrolled, 93% were successfully assigned an appropriateness level. Inappropriate use of MPI was found in 14.4% of patients, with a range of 4% to 22% among practices. Women and younger patients were more likely to undergo inappropriate MPI. Asymptomatic, low-risk patients accounted for 44.5% of inappropriate testing. Elimination of the 5 most common inappropriate use indications would reduce overall imaging volume by 13.2%. Inappropriate use by physicians from within the practice performing imaging was not greater than physicians outside of the practice. Educational feedback might have resulted in reduced inappropriate test ordering in 1 site. Conclusions: The tracking of appropriate use is feasible in clinical practice, with an automated system that can readily identify practice patterns and targets for educational and quality improvement initiatives. This approach might provide an alternative to utilization management.

KW - appropriateness criteria

KW - diagnostic testing

KW - radionuclide imaging

KW - SPECT

UR - http://www.scopus.com/inward/record.url?scp=73049086777&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=73049086777&partnerID=8YFLogxK

U2 - 10.1016/j.jacc.2009.11.004

DO - 10.1016/j.jacc.2009.11.004

M3 - Article

C2 - 20117384

AN - SCOPUS:73049086777

VL - 55

SP - 156

EP - 162

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

SN - 0735-1097

IS - 2

ER -