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Quality improvement interventions may reduce inappropriate cardiac imaging
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The use of physician audit and feedback mechanisms, as well as other quality improvement interventions, reduced inappropriate cardiac imaging, according to study findings published in Circulation: Cardiovascular Quality and Outcomes.
Researchers at McMaster University in Hamilton, Ontario, Canada, conducted a systematic review and random-effects meta-analysis of studies that evaluated the effectiveness of quality improvement initiatives on inappropriate cardiac imaging.
The primary outcome was the proportion of inappropriate tests based upon the American College of Cardiology Foundation appropriate use criteria. Through subgroup analyses, the researchers also assessed heterogeneity.
In the six observational studies and one randomized control trial identified, six interventions included a formal education component and five had a mechanism for physician audit and feedback. Each of the interventions involved at least one of the following cardiac imaging modalities: single-photon emission CT myocardial perfusion imaging, echocardiography, cardiac MRI and cardiac CTA.
According to the researchers, all of the quality improvement interventions were correlated with lower odds of inappropriate testing (OR = 0.44; 95% CI, 0.32-0.61), but the use of physician audit and feedback mechanism was associated with lower odds (OR = 0.36; 95% CI, 0.31-0.41) compared with those without physician audits and feedback mechanisms (OR = 0.89; 95% CI, 0.61-1.29). The researchers observed significant heterogeneity between studies (I2 = 70%). Heterogeneity estimates may be affected by the small number of studies included in the meta-analysis, according to the researchers.
“The impact of physician audit and feedback mechanisms may also be partly related to a Hawthorn[e] effect, where the simple awareness of a performance audit may lead to changes in behavior to improve referral practices,” the researchers wrote. “In this regard, a chief concern is whether the impact of quality improvement initiatives will lessen over time, particularly if they are not maintained.
“Future studies that evaluate diverse interventions using improved designs are needed to determine the most effective strategies for reducing inappropriate cardiac testing,” they wrote. – by Tracey Romero
Disclosure: The researchers report no relevant financial disclosures.
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