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

Kavitha M. Chinnaiyan, Patricia Peyser, Tauqir Goraya, Karthikeyan Ananthasubramaniam, Michael Gallagher, Ann Depetris, Judith A. Boura, Ella Kazerooni, Chad Poopat, Mouaz Al-Mallah, Souheil Saba, Smita Patel, Steven Girard, Thomas Song, David Share, Gilbert Raff

Research output: Contribution to journalArticle

57 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1185-1191
Number of pages7
JournalJournal of the American College of Cardiology
Volume60
Issue number13
DOIs
StatePublished - Sep 25 2012
Externally publishedYes

Keywords

  • ACIC
  • appropriate use
  • coronary computed tomography angiography

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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