Abstract:
Background : As the volume of cardiac imaging continues to
increase, so is the number of tests performed for rarely appropriate
indications. Appropriate use criteria (AUC) documents were published by
professional societies with quality improvement (QI) interventions
developed in various institutions. However, the effectiveness of these
interventions has not been assessed in a systematic fashion.
Methods: We performed a database search for studies reporting
the association between cardiac imaging, AUC and QI. We selected studies
assessing the effect of QI interventions on performance of rarely
appropriate echocardiograms. The primary endpoint was reduction of
rarely appropriate testing.
Results: Nine studies with 22,070 patients met inclusion
criteria. QI interventions resulted in statistically significant
reduction in rarely appropriate tests (OR 0.52, 95% CI 0.41-0.66;
p<0.01). The effects of QI interventions were analyzed over
both the short (< 3 months) and long-term (> 3
months) post intervention (OR 0.62, 95% CI: 0.49-0.79; p<0.01
in the short term, and OR 0.47, 95% CI: 0.35-0.62; p<0.01 in
the long term). Subgroup analysis of the type of intervention,
classified as education tools or decision support tools showed both
significantly reduced rarely appropriate testing (OR 0.54, 95% CI:
0.41-0.73; p<0.01; OR 0.47, 95% CI: 0.36-0.61;
p<0.01). Adding a feedback tool did not change the effect
compared to not using a feedback tool (OR 0.49 vs. 0.57, 95% CI:
0.36-0.68 vs. 0.39-0.84; p>0.05).
Conclusion: QI interventions are associated with a significant
reduction in performance of rarely appropriate echocardiography testing,
the effects of which persist over time.