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Guideline-based decision support has a small, non-sustained effect on transthoracic echocardiography ordering frequency.

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2.1 Mb
Date
2016-01
Authors
Boggan, JC
Schulteis, RD
Donahue, M
Simel, DL
Repository Usage Stats
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131
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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 article
Subject
Control charts, run charts
Decision 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
Permalink
https://hdl.handle.net/10161/12046
Published Version (Please cite this version)
10.1136/bmjqs-2015-004284
Publication 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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Scholars@Duke

Boggan

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
Donahue

Mark Paul Donahue

Associate Professor of Medicine
Schulteis

Ryan D Schulteis

Assistant Professor of Medicine
Simel

David Lee Simel

Professor 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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