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Effect of Release of the First Pediatric Appropriate Use Criteria on Transthoracic Echocardiogram Ordering Practice.

Publication ,  Journal Article
Sachdeva, R; Douglas, PS; Kelleman, MS; McCracken, CE; Lopez, L; Stern, KWD; Eidem, BW; Benavidez, OJ; Weiner, RB; Welch, E; Campbell, RM; Lai, WW
Published in: Am J Cardiol
November 15, 2016

Pediatric appropriate use criteria (AUC) were recently published for initial outpatient transthoracic echocardiography (TTE). The purpose of this study was to determine the effect of AUC publication on TTE ordering patterns of pediatric cardiologists. Data were prospectively collected on patients who had initial outpatient TTE ordered before (phase I, April to September 2014) and 3 months after (phase II, January to April 2015) AUC document publication at 6 centers. Site investigators assessed each study's indication and assigned AUC appropriateness as "appropriate" (A), "may be appropriate" (M), "rarely appropriate" (R), or "unclassifiable." One hundred three physicians ordered 4,562 TTEs (2,655 phase I and 1,907 phase II). Overall, there was no statistically significant change in the proportion of A, M, or unclassifiable, but R decreased (12.0% to 9.6%, p = 0.01). There was significant variability among the centers in the percentage of studies for indications rated R (4.9% to 34.8%). There was no significant change in any of the appropriateness ratings at 4 centers, a decrease in R and an increase in A at 1 and a decrease in R and increase in unclassifiable at another. The first pediatric AUC document had only a small impact on physician ordering behavior for initial TTEs, including a small decrease in R. There was a significant variability in appropriateness of studies among centers. These data suggest that active educational interventions are required to substantially improve the appropriate use of pediatric TTE in the outpatient setting.

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Published In

Am J Cardiol

DOI

EISSN

1879-1913

Publication Date

November 15, 2016

Volume

118

Issue

10

Start / End Page

1545 / 1551

Location

United States

Related Subject Headings

  • Utilization Review
  • Unnecessary Procedures
  • Time Factors
  • Quality Control
  • Prospective Studies
  • Practice Patterns, Physicians'
  • Male
  • Humans
  • Heart Defects, Congenital
  • Guideline Adherence
 

Citation

APA
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MLA
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Sachdeva, R., Douglas, P. S., Kelleman, M. S., McCracken, C. E., Lopez, L., Stern, K. W. D., … Lai, W. W. (2016). Effect of Release of the First Pediatric Appropriate Use Criteria on Transthoracic Echocardiogram Ordering Practice. Am J Cardiol, 118(10), 1545–1551. https://doi.org/10.1016/j.amjcard.2016.08.019
Sachdeva, Ritu, Pamela S. Douglas, Michael S. Kelleman, Courtney E. McCracken, Leo Lopez, Kenan W. D. Stern, Benjamin W. Eidem, et al. “Effect of Release of the First Pediatric Appropriate Use Criteria on Transthoracic Echocardiogram Ordering Practice.Am J Cardiol 118, no. 10 (November 15, 2016): 1545–51. https://doi.org/10.1016/j.amjcard.2016.08.019.
Sachdeva R, Douglas PS, Kelleman MS, McCracken CE, Lopez L, Stern KWD, et al. Effect of Release of the First Pediatric Appropriate Use Criteria on Transthoracic Echocardiogram Ordering Practice. Am J Cardiol. 2016 Nov 15;118(10):1545–51.
Sachdeva, Ritu, et al. “Effect of Release of the First Pediatric Appropriate Use Criteria on Transthoracic Echocardiogram Ordering Practice.Am J Cardiol, vol. 118, no. 10, Nov. 2016, pp. 1545–51. Pubmed, doi:10.1016/j.amjcard.2016.08.019.
Sachdeva R, Douglas PS, Kelleman MS, McCracken CE, Lopez L, Stern KWD, Eidem BW, Benavidez OJ, Weiner RB, Welch E, Campbell RM, Lai WW. Effect of Release of the First Pediatric Appropriate Use Criteria on Transthoracic Echocardiogram Ordering Practice. Am J Cardiol. 2016 Nov 15;118(10):1545–1551.
Journal cover image

Published In

Am J Cardiol

DOI

EISSN

1879-1913

Publication Date

November 15, 2016

Volume

118

Issue

10

Start / End Page

1545 / 1551

Location

United States

Related Subject Headings

  • Utilization Review
  • Unnecessary Procedures
  • Time Factors
  • Quality Control
  • Prospective Studies
  • Practice Patterns, Physicians'
  • Male
  • Humans
  • Heart Defects, Congenital
  • Guideline Adherence