Quality improvement program reduces rate of inappropriate cardiac catheterizations

SAN DIEGO — Implementation of a screening and education program targeting primary care physicians significantly lowered the rate of inappropriate cardiac catheterizations at a rural tertiary care medical center, according to data presented at the Society for Cardiovascular Angiography and Interventions Scientific Sessions.

Talwinder Kahlon, MD, and colleagues developed an outpatient cath program at Geisinger Medical Center in Pennsylvania. The program was designed to reduce the rate of inappropriate cardiac catheterization procedures by educating PCPs who directly refer patients for cardiac catheterization and screening patients both at scheduling and upon arrival for the procedure.

Talwinder Kahlon

In the event that a referral was identified as potentially inappropriate through the screening process, the referring physicians were contacted for additional information and to discuss possible treatment alternatives. Patients received catheterization if the additional information provided sufficient justification. Appropriateness was measured according to the 2012 Appropriate Use Criteria for Diagnostic Catheterization developed by the American College of Cardiology, the American Heart Association and SCAI.

The analysis included data from the charts of all patients directly referred for elective cardiac catheterization by PCPs, as well as a randomly selected group of patients referred for catheterization by cardiologists 12 months before and 12 months after implementation of the program. The population consisted of 79 directly referred patients and 176 referred by cardiologists before the program launch, and 52 directly referred patients and 240 referred by cardiologists after the program launch.

At baseline, inappropriate catheterization was significantly more frequent among patients who received a direct referral from a PCP (15% vs. 2% among those referred by cardiologists; P = .0002). The incidence rate was also higher among directly referred patients prior to initiation of the program, with zero cases of inappropriate catheterization following its launch (15% vs. 0%; P = .003).

“The intent of appropriate use criteria has been to assist practitioners in the delivery of care,” Charles Chambers, MD, FSCAI, past president of SCAI, said in a press release. “This study demonstrates how appropriate use criteria should be applied, namely to support clinicians’ efforts to improve quality.” – by Adam Taliercio

Reference:

Kahlon T, et al. Best of the Best Abstracts. Presented at: Society for Cardiovascular Angiography and Interventions Scientific Sessions: May 6-9, 2015; San Diego.

Disclosure: The researchers report no relevant financial disclosures.