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Quality Improvement Implementation: Improving Reproducibility in the Echocardiography Laboratory.

Publication ,  Journal Article
Daubert, MA; Yow, E; Barnhart, HX; Rabineau, D; Crowley, AL; Douglas, PS
Published in: J Am Soc Echocardiogr
August 2015

BACKGROUND: Interpretative variability can adversely affect echocardiographic reliability, but there is no widely accepted method to minimize variability and improve reproducibility. METHODS: A continuous quality improvement process was devised that involves testing reproducibility by assessment of measurement differences followed by robust review, retraining, and retesting. Reproducibility was deemed acceptable if ≥80% of all interreader comparisons were within a prespecified acceptable difference. Readers not meeting this standard underwent retraining and retesting until acceptable reproducibility was achieved for the following parameters: left ventricular end-diastolic volume, biplane ejection fraction, mitral and aortic regurgitation, left ventricular outflow tract diameter, peak and mean aortic valve gradients, and aortic valve area. Eight hundred interreader comparisons for evaluation of reproducibility were generated from five readers interpreting 10 echocardiograms per testing cycle. The applicability and efficacy of this method were then evaluated by testing a second larger group of 10 readers and reevaluating reproducibility 1 year later. RESULTS: All readers demonstrated acceptable reproducibility for biplane ejection fraction, mitral regurgitation, and peak and mean aortic valve gradients. Acceptable reproducibility for left ventricular end-diastolic volume, aortic regurgitation, and aortic valve area was achieved by four of five readers. No readers attained acceptable reproducibility on initial evaluation of left ventricular outflow tract diameter. After review and retraining, all readers demonstrated acceptable reproducibility, which was maintained on subsequent testing 1 year later. A second larger group of 10 readers was also evaluated and yielded similar results. CONCLUSIONS: A continuous quality improvement process was devised that successfully reduced interpretative variability in echocardiography and improved reproducibility that was sustained over time.

Duke Scholars

Published In

J Am Soc Echocardiogr

DOI

EISSN

1097-6795

Publication Date

August 2015

Volume

28

Issue

8

Start / End Page

959 / 968

Location

United States

Related Subject Headings

  • Sensitivity and Specificity
  • Reproducibility of Results
  • Radiology
  • Quality Improvement
  • Observer Variation
  • North Carolina
  • Humans
  • Heart Diseases
  • Echocardiography
  • Clinical Competence
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Daubert, M. A., Yow, E., Barnhart, H. X., Rabineau, D., Crowley, A. L., & Douglas, P. S. (2015). Quality Improvement Implementation: Improving Reproducibility in the Echocardiography Laboratory. J Am Soc Echocardiogr, 28(8), 959–968. https://doi.org/10.1016/j.echo.2015.03.004
Daubert, Melissa A., Eric Yow, Huiman X. Barnhart, Dawn Rabineau, Anna Lisa Crowley, and Pamela S. Douglas. “Quality Improvement Implementation: Improving Reproducibility in the Echocardiography Laboratory.J Am Soc Echocardiogr 28, no. 8 (August 2015): 959–68. https://doi.org/10.1016/j.echo.2015.03.004.
Daubert MA, Yow E, Barnhart HX, Rabineau D, Crowley AL, Douglas PS. Quality Improvement Implementation: Improving Reproducibility in the Echocardiography Laboratory. J Am Soc Echocardiogr. 2015 Aug;28(8):959–68.
Daubert, Melissa A., et al. “Quality Improvement Implementation: Improving Reproducibility in the Echocardiography Laboratory.J Am Soc Echocardiogr, vol. 28, no. 8, Aug. 2015, pp. 959–68. Pubmed, doi:10.1016/j.echo.2015.03.004.
Daubert MA, Yow E, Barnhart HX, Rabineau D, Crowley AL, Douglas PS. Quality Improvement Implementation: Improving Reproducibility in the Echocardiography Laboratory. J Am Soc Echocardiogr. 2015 Aug;28(8):959–968.
Journal cover image

Published In

J Am Soc Echocardiogr

DOI

EISSN

1097-6795

Publication Date

August 2015

Volume

28

Issue

8

Start / End Page

959 / 968

Location

United States

Related Subject Headings

  • Sensitivity and Specificity
  • Reproducibility of Results
  • Radiology
  • Quality Improvement
  • Observer Variation
  • North Carolina
  • Humans
  • Heart Diseases
  • Echocardiography
  • Clinical Competence