Guideline-based decision support has a small, non-sustained effect on transthoracic echocardiography ordering frequency.
Abstract
BACKGROUND: Guidance for appropriate utilisation of transthoracic echocardiograms
(TTEs) can be incorporated into ordering prompts, potentially affecting the number
of requests. METHODS: We incorporated data from the 2011 Appropriate Use Criteria
for Echocardiography, the 2010 National Institute for Clinical Excellence Guideline
on Chronic Heart Failure, and American College of Cardiology Choosing Wisely list
on TTE use for dyspnoea, oedema and valvular disease into electronic ordering systems
at Durham Veterans Affairs Medical Center. Our primary outcome was TTE orders per
month. Secondary outcomes included rates of outpatient TTE ordering per 100 visits
and frequency of brain natriuretic peptide (BNP) ordering prior to TTE. Outcomes were
measured for 20 months before and 12 months after the intervention. RESULTS: The number
of TTEs ordered did not decrease (338±32 TTEs/month prior vs 320±33 afterwards, p=0.12).
Rates of outpatient TTE ordering decreased minimally post intervention (2.28 per 100
primary care/cardiology visits prior vs 1.99 afterwards, p<0.01). Effects on TTE ordering
and ordering rate significantly interacted with time from intervention (p<0.02 for
both), as the small initial effects waned after 6 months. The percentage of TTE orders
with preceding BNP increased (36.5% prior vs 42.2% after for inpatients, p=0.01; 10.8%
prior vs 14.5% after for outpatients, p<0.01). CONCLUSIONS: Ordering prompts for TTEs
initially minimally reduced the number of TTEs ordered and increased BNP measurement
at a single institution, but the effect on TTEs ordered was likely insignificant from
a utilisation standpoint and decayed over time.
Type
Journal articleSubject
Control charts, run chartsDecision support, computerized
Quality improvement
Statistical process control
Decision Making, Computer-Assisted
Echocardiography
Guideline Adherence
Humans
Natriuretic Peptide, Brain
Practice Patterns, Physicians'
Tertiary Care Centers
Unnecessary Procedures
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https://hdl.handle.net/10161/12046Published Version (Please cite this version)
10.1136/bmjqs-2015-004284Publication Info
Boggan, JC; Schulteis, RD; Donahue, M; & Simel, DL (2016). Guideline-based decision support has a small, non-sustained effect on transthoracic
echocardiography ordering frequency. BMJ Qual Saf, 25(1). pp. 57-62. 10.1136/bmjqs-2015-004284. Retrieved from https://hdl.handle.net/10161/12046.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Joel Boggan
Associate Professor of Medicine
I am a hospital medicine physician interested in quality improvement, patient safety,
and medical education across the UME, GME, and CME environments. My current QI and
research projects include work on readmissions, inpatient ORYX and patient experience
measures, clinical documentation improvement, medication reconciliation, and appropriate
utilization of inpatient resources. Alongside this work, I serve as the lead mentor
for our Durham VA Chief Resident in Quality and Safety within the Depart
Mark Paul Donahue
Associate Professor of Medicine
Ryan D Schulteis
Assistant Professor of Medicine
David Lee Simel
Professor Emeritus of Medicine
Chief, Medical Service, Durham Veterans Affairs Medical CenterAppropriateness of diagnostic
test use, including not just traditional laboratory and radiographic tests, but also
the clinical examination. Editor of the "Rational Clinical Examination Series" published
in the Journal of the American Medical Association. Metaanalysis of diagnostic test
studies
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