Quality improvement interventions may reduce inappropriate cardiac imaging

A systematic review of seven studies found that quality improvement initiatives helped reduce inappropriate cardiac imaging. The most successful interventions featured physician audit and feedback capabilities. 

Lead author Dipayan Chaudhuri, BHSc, of McMaster University in Ontario, Canada, and colleagues published their results online in Circulation: Cardiovascular Quality and Outcomes on Jan. 5.

They cited data that estimated between 5 percent and 25 percent of cardiac imaging tests are inappropriate. Several years ago, the American College of Cardiology released appropriate use criteria to decrease the number of inappropriate testes and reduce healthcare costs. Since then, numerous quality improvement interventions have been developed to implement the appropriate use criteria, but their effectiveness have varied.

In this analysis the researchers searched the MEDLINE and EMBASE databases for randomized controlled and observational studies published after the year 2000 that measured outcomes using appropriate use criteria. They identified trials of quality improvement interventions that included at least one of the following cardiac imaging modalities: single photon emission computed tomographic myocardial perfusion imaging; echocardiography; cardiac magnetic resonance imaging; and cardiac computed tomographic angiography.

They evaluated 13,012 adults from seven studies conducted in the U.S.: six were observational and one was a randomized control trial. Five of the studies had interventions that focused on a specific cardiac imaging modality, while two examined multiple cardiac imaging modalities. In addition, six studies included a formal educational component, two used point of care decision support tools and five included a process for physician audit and feedback.

The researchers mentioned that the quality improvement interventions were associated with significantly lower odds of inappropriate testing, although there was significant heterogeneity between the studies. Interventions that featured a physician audit and feedback mechanism had lower odds of inappropriate testing.

The small number of studies in this review may limit its generalizability, according to the researchers. They also said most of the initiatives were focused on education-based interventions and only one evaluated an alternative, real-time, computer-based decision support tool.

“Quality improvement interventions are associated with a reduction in inappropriate cardiac testing, although these benefits seem to be closely tied to the use of physician audit and feedback mechanisms,” the researchers wrote. “Further studies that evaluate diverse interventions using improved designs are needed to determine the most effective strategies for reducing inappropriate cardiac testing.”