TY - JOUR
T1 - Application of Appropriateness Criteria in Outpatient Transthoracic Echocardiography
AU - Kirkpatrick, James N.
AU - Ky, Bonnie
AU - Rahmouni, Hind W.
AU - Chirinos, Julio A.
AU - Farmer, Steven A.
AU - Fields, Anjali V.
AU - Ogbara, Jeffrey
AU - Eberman, Karen M.
AU - Ferrari, Victor A.
AU - Silvestry, Frank E.
AU - Keane, Martin G.
AU - Opotowsky, Alexander R.
AU - Sutton, Martin St John
AU - Wiegers, Susan E.
PY - 2009/1
Y1 - 2009/1
N2 - Background: Appropriateness criteria were applied to outpatient transthoracic echocardiographic (TTE) studies. Methods: Indications were rated as appropriate, inappropriate, or unclassifiable, considering provider-stated indications, previous TTE studies, symptom changes, and patient-stated indications. Clinically important new or unexpected findings were recorded. Results: Of 368 TTE studies, 206 (56%) were appropriate, 31 (8%) were inappropriate, and 131 (35%) were unclassifiable. Appropriateness was not correlated with patient or provider demographics. In 288 cases with prior TTE studies, there were 92 (32%) important new findings and 63 (22%) unexpected findings, of which 20% were from inappropriately ordered and 31% from unclassifiable TTE studies. Appropriateness was not associated with new (odds ratio, 1.23; 95% confidence interval, 0.48-3.18) or unexpected (odds ratio, 1.15; 95% confidence interval, 0.38-3.52) findings. Provider type and level of training were not correlated with new or unexpected findings. Conclusions: Many indications for TTE studies were unclassifiable. A high percentage of inappropriately ordered TTE studies yielded important information. Care must be taken in judging the value of TTE studies solely on the basis of appropriateness criteria.
AB - Background: Appropriateness criteria were applied to outpatient transthoracic echocardiographic (TTE) studies. Methods: Indications were rated as appropriate, inappropriate, or unclassifiable, considering provider-stated indications, previous TTE studies, symptom changes, and patient-stated indications. Clinically important new or unexpected findings were recorded. Results: Of 368 TTE studies, 206 (56%) were appropriate, 31 (8%) were inappropriate, and 131 (35%) were unclassifiable. Appropriateness was not correlated with patient or provider demographics. In 288 cases with prior TTE studies, there were 92 (32%) important new findings and 63 (22%) unexpected findings, of which 20% were from inappropriately ordered and 31% from unclassifiable TTE studies. Appropriateness was not associated with new (odds ratio, 1.23; 95% confidence interval, 0.48-3.18) or unexpected (odds ratio, 1.15; 95% confidence interval, 0.38-3.52) findings. Provider type and level of training were not correlated with new or unexpected findings. Conclusions: Many indications for TTE studies were unclassifiable. A high percentage of inappropriately ordered TTE studies yielded important information. Care must be taken in judging the value of TTE studies solely on the basis of appropriateness criteria.
KW - Appropriateness
KW - Echocardiography
KW - Outpatient
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U2 - 10.1016/j.echo.2008.10.020
DO - 10.1016/j.echo.2008.10.020
M3 - Article
C2 - 19131002
AN - SCOPUS:58149091284
VL - 22
SP - 53
EP - 59
JO - Journal of the American Society of Echocardiography
JF - Journal of the American Society of Echocardiography
SN - 0894-7317
IS - 1
ER -