KEY TAKEAWAY: Examines whether ordering transthoracic echocardiography according to appropriate use criteria impacts long-term clinical management and downstream cardiac resource utilization. Appropriate baseline imaging was associated with improved guideline-directed therapy and reduced downstream rehospitalizations.
Abstract
Background
Interventions aimed at reducing low-value care and testing may be effective in changing physician practice. While important, such interventions may also lead to unintended consequences. These include under- or over-utilization of ancillary testing or adverse clinical outcomes. Our objective was to determine the impact of an intervention aimed at reducing the proportion of rarely appropriate transthoracic echocardiography (TTE) on utilization of ancillary services and clinical outcomes for
Methods and Results
A retrospective cohort of outpatients with CAD and HF was obtained using administrative databases to identify patients with at least one visit to an Ontario-based Cardiologist in a randomized controlled trial (the EchoWISELY Study) between April 30, 2015 and April 30, 2016. Cardiologists were randomized to either receive audit-and-feedback on the appropriate use criteria for TTE or to perform usual practice. The primary outcomes were related to healthcare utilization and included rates of
Conclusion
This study provided reassurance that despite implementation of an intervention within a larger randomized controlled trial that successfully reduced rarely appropriate TTE, there was no difference in the utilization of ancillary testing or clinical outcomes such as patient visits, hospitalization, or death among patients with CAD or HF.