Clinical Utility of Guideline-Based Echocardiography: A Prospective Study of Outpatient Referral Patterns at a Tertiary Care Center

Paolo Barbier, Marina Alimento, Giovanni Berna

Research output: Contribution to journalArticle

Abstract

Background: The spread of echocardiography has increased the number of requests for echocardiography and the length of patient waiting lists in National Health Systems. This overuse of echocardiography may also result in a decrease in examination quality because of an excess in workload. The recommended use of guidelines for the requesting of echocardiograms could reduce the demand for this investigation and thus reduce both workload and health care costs. Methods: In a prospective study of 520 outpatients in a large tertiary referral center, we analyzed adherence by family physicians and cardiovascular specialists to published guidelines for requesting echocardiograms; the use of a written indication justifying the request for the first and subsequent examinations; the diagnostic outcome; and the clinical utility of each echocardiogram performed. Results: Most echocardiograms (72%) were requested by specialists, follow-ups were frequent (72%), and 14% of these proved normal. Among first examinations, 49% of those requested by family physicians and 36% of those requested by specialists were normal (P = not significant [NS]); in both groups 27% of the requests lacked a written indication. Family physicians requested echocardiograms chiefly for arterial hypertension, palpitations, chest pain, and valve disease, whereas specialists most often requested echocardiograms for checking valve prostheses, ischemic heart disease, and valve disease. The rate of adherence to guidelines (54% vs 52%, P = NS) and clinical utility (60% vs 61%, P = NS) was low and similar for family physicians and specialists. Provision of a written indication for the examination by the requesting physician correlated strongly to the clinical utility of the test (P <.001), and adherence of indication to guidelines was the major determinant of clinical utility at logistic regression analysis (P <.001). Conclusion: The rate of adherence to guidelines was lower than desirable and similar for family physicians and cardiovascular specialists. Adherence to guidelines and provision of a written specific indication strongly enhanced the value of the echocardiographic investigation.

Original languageEnglish
Pages (from-to)1010-1015
Number of pages6
JournalJournal of the American Society of Echocardiography
Volume21
Issue number9
DOIs
Publication statusPublished - Sep 2008

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Tertiary Care Centers
Family Physicians
Echocardiography
Outpatients
Referral and Consultation
Prospective Studies
Guidelines
Guideline Adherence
Workload
Waiting Lists
Heart Valves
Chest Pain
Health Care Costs
Prostheses and Implants
Myocardial Ischemia
Logistic Models
Regression Analysis
Hypertension
Physicians
Health

Keywords

  • Clinical utility
  • Echocardiography
  • Guidelines
  • Indications

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

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title = "Clinical Utility of Guideline-Based Echocardiography: A Prospective Study of Outpatient Referral Patterns at a Tertiary Care Center",
abstract = "Background: The spread of echocardiography has increased the number of requests for echocardiography and the length of patient waiting lists in National Health Systems. This overuse of echocardiography may also result in a decrease in examination quality because of an excess in workload. The recommended use of guidelines for the requesting of echocardiograms could reduce the demand for this investigation and thus reduce both workload and health care costs. Methods: In a prospective study of 520 outpatients in a large tertiary referral center, we analyzed adherence by family physicians and cardiovascular specialists to published guidelines for requesting echocardiograms; the use of a written indication justifying the request for the first and subsequent examinations; the diagnostic outcome; and the clinical utility of each echocardiogram performed. Results: Most echocardiograms (72{\%}) were requested by specialists, follow-ups were frequent (72{\%}), and 14{\%} of these proved normal. Among first examinations, 49{\%} of those requested by family physicians and 36{\%} of those requested by specialists were normal (P = not significant [NS]); in both groups 27{\%} of the requests lacked a written indication. Family physicians requested echocardiograms chiefly for arterial hypertension, palpitations, chest pain, and valve disease, whereas specialists most often requested echocardiograms for checking valve prostheses, ischemic heart disease, and valve disease. The rate of adherence to guidelines (54{\%} vs 52{\%}, P = NS) and clinical utility (60{\%} vs 61{\%}, P = NS) was low and similar for family physicians and specialists. Provision of a written indication for the examination by the requesting physician correlated strongly to the clinical utility of the test (P <.001), and adherence of indication to guidelines was the major determinant of clinical utility at logistic regression analysis (P <.001). Conclusion: The rate of adherence to guidelines was lower than desirable and similar for family physicians and cardiovascular specialists. Adherence to guidelines and provision of a written specific indication strongly enhanced the value of the echocardiographic investigation.",
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N2 - Background: The spread of echocardiography has increased the number of requests for echocardiography and the length of patient waiting lists in National Health Systems. This overuse of echocardiography may also result in a decrease in examination quality because of an excess in workload. The recommended use of guidelines for the requesting of echocardiograms could reduce the demand for this investigation and thus reduce both workload and health care costs. Methods: In a prospective study of 520 outpatients in a large tertiary referral center, we analyzed adherence by family physicians and cardiovascular specialists to published guidelines for requesting echocardiograms; the use of a written indication justifying the request for the first and subsequent examinations; the diagnostic outcome; and the clinical utility of each echocardiogram performed. Results: Most echocardiograms (72%) were requested by specialists, follow-ups were frequent (72%), and 14% of these proved normal. Among first examinations, 49% of those requested by family physicians and 36% of those requested by specialists were normal (P = not significant [NS]); in both groups 27% of the requests lacked a written indication. Family physicians requested echocardiograms chiefly for arterial hypertension, palpitations, chest pain, and valve disease, whereas specialists most often requested echocardiograms for checking valve prostheses, ischemic heart disease, and valve disease. The rate of adherence to guidelines (54% vs 52%, P = NS) and clinical utility (60% vs 61%, P = NS) was low and similar for family physicians and specialists. Provision of a written indication for the examination by the requesting physician correlated strongly to the clinical utility of the test (P <.001), and adherence of indication to guidelines was the major determinant of clinical utility at logistic regression analysis (P <.001). Conclusion: The rate of adherence to guidelines was lower than desirable and similar for family physicians and cardiovascular specialists. Adherence to guidelines and provision of a written specific indication strongly enhanced the value of the echocardiographic investigation.

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