Appropriateness vs value: Echocardiography in primary care

Abstract

Background Despite efforts targeting the growth of healthcare spending within the United States, the current increase in expenditures remains a widespread systemic issue. The overuse of healthcare testing has previously been identified as a modifiable contributing factor. One such test, echocardiography, has seen a continuous increase in its rate of use. This test is frequently ordered by primary‐care physicians. Hypothesis In the setting of a low likelihood of disease, echocardiography does not substantially change cardiac therapy, even if appropriately ordered. Methods We randomly identified 500 patients who received an echocardiogram ordered by a primary‐care physician between January 1, 2014, and December 31, 2014. Of these, 239 patient charts were reviewed and the following extracted: primary indication for the test, echocardiogram results, and changes in patient medical management. In addition, appropriateness of the test was assessed using the appropriate use criteria guidelines for echocardiography. Results Nearly 97% of the studies within the ambulatory primary‐care setting were appropriately ordered according to the appropriate use criteria. Among the 239 patients studied, only 52 had abnormalities and only 6 (2.5%) experienced a change in management that corresponded with the initial suspected diagnosis and echocardiographic findings. Conclusions To ensure the greatest value and optimize use of diagnostic testing, it may be necessary to develop a more comprehensive set of guidelines to assist clinicians to readily identify patient populations at low, moderate, and high risk for the presence of disease and provide educational interventions, including feedback regarding individual ordering behaviors.

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Patient screening for early detection of aortic stenosis (AS)—review of current practice and future perspectives

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Impact of Incorporating Echocardiographic Screening into a Clinical Prediction Model to Optimize Utilization of Echocardiography in Primary Care

“…Echocardiography (echo) remains one of the most used imaging modalities in clinical practice, providing incremental information with low risk to the patient by employing ultrasound technology 1,2 . The availability of portable and affordable machines has allowed echocardiography to go beyond the frontiers of specialized centers, and its indications have progressively increased, being frequently ordered by primary-care physicians 3,4 . In response to marked increases in utilization of echocardiography, the delay in its access is inevitable.…”

“…The first consideration of healthcare providers is that the waiting list is a direct measure of the need for medicals services, and that the size of the list is directly related to the need. However, in a setting of low likelihood of cardiovascular disease, echocardiography does not substantially change cardiovascular therapeutics, even if appropriately ordered 4 .…”

“…Despite the increasing interest of healthcare managers, limited data are available to enhance physician awareness and education about optimal utilization of imaging, especially when indications were given by non-cardiologists 2 . Several implications for practice point towards the importance of adequately defining the likelihood of disease rather than appropriateness of testing and impact on outcome for management of diagnostic flowcharts 4,8 .…”