Impact of a Continuous Quality Improvement Initiative on Appropriate Use of Coronary Computed Tomography Angiography Results From a Multicenter, Statewide Registry, the Advanced Cardiovascular Imaging Consortium

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:60

Article

Chinnaiyan, Kavitha M.¹  Peyser, Patricia²  Goraya, Tauqir³  Ananthasubramaniam, Karthikeyan⁴  Gallagher, Michael¹  DePetris, Ann¹  Boura, Judith A.¹  Kazerooni, Ella²  Poopat, Chad⁴  Al-Mallah, Mouaz⁵  Saba, Souheil⁶  Patel, Smita²  Girard, Steven³  Song, Thomas⁴  Share, David⁷  Raff, Gilbert¹ 

[1] William Beaumont Hosp, Royal Oak, MI 48073 USA

[2] Univ Michigan, Ann Arbor, MI 48109 USA

[3] Michigan Heart PC, Ypsilanti, MI USA

[4] Henry Ford Hlth Syst, Detroit, MI USA

[5] King Abdulaziz Cardiac Ctr, Riyadh, Saudi Arabia

[6] St John Providence Hosp, Southfield, MI USA

[7] Blue Cross Blue Shield Blue Care Network Michigan, Southfield, MI USA

关键词: ACIC;    appropriate use;    coronary computed tomography angiography;   

DOI  :  10.1016/j.jacc.2012.06.008

来源: Elsevier

【 摘 要 】

Objectives The purpose of the study was to determine the effectiveness of a collaborative educational, continuous quality improvement (CQI) initiative to increase appropriate use of coronary computed tomography angiography (CCTA). Background Potential overuse of CCTA has prompted multisociety appropriate use criteria (AUC) publications. Methods This prospective, observational study was conducted with pre-intervention (July 2007 to June 2008), intervention (July 2008 to June 2010), and follow-up (July 2010 to December 2010) periods during which patients were enrolled in the Advanced Cardiovascular Imaging Consortium (ACIC) at 47 Michigan hospitals. Continuous education was provided to referring physicians. The possibility of losing third-party payer coverage in the absence of a measurable change in AUC was emphasized. AUC was compared between the 3 periods. Results The study group included 25,387 patients. Compared with the pre-intervention period, there was a 23.4% increase in appropriate (61.3% to 80%, p < 0.0001), 60.3% decrease in inappropriate (14.6% to 5.8%, p < 0.0001), 40.8% decrease in uncertain (10.3% to 6.1%, p < 0.0001), and 41.7% decrease in unclassifiable (13.9% to 8.1%, p < 0.0001) scans during follow-up. Between pre-intervention and follow-up, change in CCTA referrals by provider specialty were cardiology (appropriate: 60.4% to 79.5%; inappropriate: 13% to 5.2%; p < 0.0001), internal medicine/family practice (appropriate: 51.1% to 70.4%; inappropriate: 20.2% to 12.5%; p < 0.0001), emergency medicine (appropriate: 83.6% to 91.6%; inappropriate: 9.1% to 0.6%; p < 0.0001), and other (appropriate: 61.1% to 83.2%; inappropriate: 18.6% to 5.9%; p < 0.0001). Conclusions Application of a systematic CQI and emphasis on possible loss of coverage were associated with a significant improvement in the proportion of CCTA examinations meeting AUC across referring physician specialties. (J Am Coll Cardiol 2012; 60: 1185-91) (C) 2012 by the American College of Cardiology Foundation

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