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.
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.
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
SN - 0894-7317
VL - 22
SP - 53
EP - 59
JO - Journal of the American Society of Echocardiography
JF - Journal of the American Society of Echocardiography
IS - 1
ER -