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CT quality improvement program helped reduce inappropriate tests

Issue: September 2012

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Application of a systematic continuous quality improvement initiative at hospitals in Michigan resulted in significant improvements in the number of coronary CT angiography examinations meeting appropriate use criteria across referring specialties.

The data come from a prospective, observational study of 25,387 patients enrolled in the Advanced Cardiovascular Imaging Consortium (ACIC) at 47 Michigan hospitals. Researchers compared appropriate use criteria (AUC) in three periods: pre-intervention (July 2008-June 2008), intervention (July 2008-June 2010) and follow-up (July 2010-December 2010).

The collaborative, educational quality improvement initiative utilized continuous education provided to referring physicians and emphasized the possibility of losing third-party payer coverage in the absence of a measurable change in appropriate use criteria, according to the abstract.

During follow-up, the proportion of appropriate CCTA examinations increased by 23.4% (61.3% to 80%); inappropriate examinations decreased by 60.3% (14.6% to 5.8%); unclassifiable examinations decreased by 41.7% (13.9% to 8.1%;); and uncertain examinations decreased by 40.8% (10.3% to 6.1%; P<.0001 for all), as compared with the pre-intervention period.

Cardiologists decreased the proportion of inappropriate examinations from 13% to 5.2% and increased appropriate examinations from 60.4% to 79.5%. Internal medicine/family practice physicians decreased the percentage of inappropriate examinations from 20.2% to 12.5% and increased appropriate examinations from 51.1% to 70.4%. Emergency medicine physicians decreased the percentage of inappropriate examinations from 9.1% to 0.6% and increased appropriate examinations from 83.6% to 91.6% (P<.0001 for all).

“Potential overuse of CCTA has prompted multisociety AUC publications,” researchers wrote. “This study presents an alternative, nontraditional approach to use management wherein physicians and payers collaborate to address the growing problem of inappropriate imaging.”

For more information:

Chinnaiyan KM. J Am Coll Cardiol. 2012;doi:10.1016/j.jacc.2012.06.008.

Disclosure: The study was funded by Blue Cross/Blue Shield/Blue Care Network of Michigan.