TY - JOUR
T1 - Impact of a continuous quality improvement initiative on appropriate use of coronary computed tomography angiography
T2 - Results from a multicenter, statewide registry, the advanced cardiovascular imaging consortium
AU - Chinnaiyan, Kavitha M.
AU - Peyser, Patricia
AU - Goraya, Tauqir
AU - Ananthasubramaniam, Karthikeyan
AU - Gallagher, Michael
AU - Depetris, Ann
AU - Boura, Judith A.
AU - Kazerooni, Ella
AU - Poopat, Chad
AU - Al-Mallah, Mouaz
AU - Saba, Souheil
AU - Patel, Smita
AU - Girard, Steven
AU - Song, Thomas
AU - Share, David
AU - Raff, Gilbert
N1 - Funding Information:
This study was funded by Blue Cross/Blue Shield/Blue Care Network of Michigan. Dr. Ananthasubramaniam has received grant support, Astellas Pharma Global Development, Inc. , GE Healthcare , Trovis Pharmaceuticals , and GlaxoSmithKline ; speakers bureau/honoraria from Astellas Pharma, Inc. and Lantheus Medical Imaging; and is a consultant/advisory board member for Lantheus Medical Imaging and Astellas Pharma. Dr. Raff has received grant support from Siemens Healthcare . Dr. Share receives salary support from Blue Cross/Blue Shield/Blue Care Network of Michigan. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Copyright:
Copyright 2013 Elsevier B.V., All rights reserved.
PY - 2012/9/25
Y1 - 2012/9/25
N2 - 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.
AB - 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.
KW - ACIC
KW - appropriate use
KW - coronary computed tomography angiography
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U2 - 10.1016/j.jacc.2012.06.008
DO - 10.1016/j.jacc.2012.06.008
M3 - Article
C2 - 22884289
AN - SCOPUS:84866356282
VL - 60
SP - 1185
EP - 1191
JO - Journal of the American College of Cardiology.
JF - Journal of the American College of Cardiology.
SN - 0735-1097
IS - 13
ER -