Application of Appropriateness Criteria in Outpatient Transthoracic Echocardiography

James N. Kirkpatrick; Bonnie Ky; Hind W. Rahmouni; Julio A. Chirinos; Steven A. Farmer; Anjali V. Fields; Jeffrey Ogbara; Karen M. Eberman; Victor A. Ferrari; Frank E. Silvestry; Martin G. Keane; Alexander R. Opotowsky; Martin St John Sutton; Susan E. Wiegers

doi:10.1016/j.echo.2008.10.020

Application of Appropriateness Criteria in Outpatient Transthoracic Echocardiography

James N. Kirkpatrick, Bonnie Ky, Hind W. Rahmouni, Julio A. Chirinos, Steven A. Farmer, Anjali V. Fields, Jeffrey Ogbara, Karen M. Eberman, Victor A. Ferrari, Frank E. Silvestry, Martin G. Keane, Alexander R. Opotowsky, Martin St John Sutton, Susan E. Wiegers

Research output: Contribution to journal › Article › peer-review

66 Scopus citations

Abstract

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.

Original language	English (US)
Pages (from-to)	53-59
Number of pages	7
Journal	Journal of the American Society of Echocardiography
Volume	22
Issue number	1
DOIs	https://doi.org/10.1016/j.echo.2008.10.020
State	Published - Jan 2009
Externally published	Yes

Keywords

Appropriateness
Echocardiography
Outpatient

ASJC Scopus subject areas

Radiology Nuclear Medicine and imaging
Cardiology and Cardiovascular Medicine

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10.1016/j.echo.2008.10.020

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Kirkpatrick, J. N., Ky, B., Rahmouni, H. W., Chirinos, J. A., Farmer, S. A., Fields, A. V., Ogbara, J., Eberman, K. M., Ferrari, V. A., Silvestry, F. E., Keane, M. G., Opotowsky, A. R., Sutton, M. S. J., & Wiegers, S. E. (2009). Application of Appropriateness Criteria in Outpatient Transthoracic Echocardiography. Journal of the American Society of Echocardiography, 22(1), 53-59. https://doi.org/10.1016/j.echo.2008.10.020

Kirkpatrick, JN, Ky, B, Rahmouni, HW, Chirinos, JA, Farmer, SA, Fields, AV, Ogbara, J, Eberman, KM, Ferrari, VA, Silvestry, FE, Keane, MG, Opotowsky, AR, Sutton, MSJ & Wiegers, SE 2009, 'Application of Appropriateness Criteria in Outpatient Transthoracic Echocardiography', Journal of the American Society of Echocardiography, vol. 22, no. 1, pp. 53-59. https://doi.org/10.1016/j.echo.2008.10.020

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title = "Application of Appropriateness Criteria in Outpatient Transthoracic Echocardiography",

abstract = "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.",

keywords = "Appropriateness, Echocardiography, Outpatient",

author = "Kirkpatrick, {James N.} and Bonnie Ky and Rahmouni, {Hind W.} and Chirinos, {Julio A.} and Farmer, {Steven A.} and Fields, {Anjali V.} and Jeffrey Ogbara and Eberman, {Karen M.} and Ferrari, {Victor A.} and Silvestry, {Frank E.} and Keane, {Martin G.} and Opotowsky, {Alexander R.} and Sutton, {Martin St John} and Wiegers, {Susan E.}",

note = "Funding Information: Kohler gratefully acknowledges the support by the Max Planck Institute for Demographic Research in Rostock, Germany, where he was head of the research group on Social Dynamics and Fertility while this research was conducted. Stark also greatly appreciates the support of the Max Planck Institute for Demographic Research, where she was visiting while major parts of this work were conducted. In addition, the authors would like to thank several scientists at the Max Planck Institute for Demographic Research for their contributions and insights, including Gunnar Andersson, Laura Bernardi, Francesco Billari, Christoph Buhler, Karsten Hank, Iliana Kohler, Michaela Kreyenfeld, Jose Antonio Ortega and Holger von der Lippe. We also appreciate the language and technical support of Annette Baudisch, Erin Sines, Raij Guerra Alonso and Nancy Vaupel.",

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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.

N1 - Funding Information: Kohler gratefully acknowledges the support by the Max Planck Institute for Demographic Research in Rostock, Germany, where he was head of the research group on Social Dynamics and Fertility while this research was conducted. Stark also greatly appreciates the support of the Max Planck Institute for Demographic Research, where she was visiting while major parts of this work were conducted. In addition, the authors would like to thank several scientists at the Max Planck Institute for Demographic Research for their contributions and insights, including Gunnar Andersson, Laura Bernardi, Francesco Billari, Christoph Buhler, Karsten Hank, Iliana Kohler, Michaela Kreyenfeld, Jose Antonio Ortega and Holger von der Lippe. We also appreciate the language and technical support of Annette Baudisch, Erin Sines, Raij Guerra Alonso and Nancy Vaupel.

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.

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KW - Echocardiography

KW - Outpatient

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Application of Appropriateness Criteria in Outpatient Transthoracic Echocardiography

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Keywords

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