Author + information
- Received March 20, 2012
- Revision received May 16, 2012
- Accepted June 5, 2012
- Published online September 25, 2012.
- Kavitha M. Chinnaiyan, MD⁎,⁎ (, )
- Patricia Peyser, PhD†,
- Tauqir Goraya, MD, PhD‡,
- Karthikeyan Ananthasubramaniam, MD§,
- Michael Gallagher, MD⁎,
- Ann DePetris, RN, MSA⁎,
- Judith A. Boura, MS⁎,
- Ella Kazerooni, MD†,
- Chad Poopat, MD§,
- Mouaz Al-Mallah, MD∥,
- Souheil Saba, MD¶,
- Smita Patel, MD†,
- Steven Girard, MD, PhD‡,
- Thomas Song, MD§,
- David Share, MD# and
- Gilbert Raff, MD⁎
- ↵⁎Reprint requests and correspondence:
Dr. Kavitha M. Chinnaiyan, William Beaumont Hospital, 3601 West 13 Mile Road, Royal Oak, Michigan 48073
Objectives The purpose of the study was to determine the effectiveness of a collaborative educational, continuous quality improvement (CQI) initiative to increase appropriate use of coronary computed tomography angiography (CCTA).
Background Potential overuse of CCTA has prompted multisociety appropriate use criteria (AUC) publications.
Methods This prospective, observational study was conducted with pre-intervention (July 2007 to June 2008), intervention (July 2008 to June 2010), and follow-up (July 2010 to December 2010) periods during which patients were enrolled in the Advanced Cardiovascular Imaging Consortium (ACIC) at 47 Michigan hospitals. Continuous education was provided to referring physicians. The possibility of losing third-party payer coverage in the absence of a measurable change in AUC was emphasized. AUC was compared between the 3 periods.
Results The study group included 25,387 patients. Compared with the pre-intervention period, there was a 23.4% increase in appropriate (61.3% to 80%, p < 0.0001), 60.3% decrease in inappropriate (14.6% to 5.8%, p < 0.0001), 40.8% decrease in uncertain (10.3% to 6.1%, p < 0.0001), and 41.7% decrease in unclassifiable (13.9% to 8.1%, p < 0.0001) scans during follow-up. Between pre-intervention and follow-up, change in CCTA referrals by provider specialty were cardiology (appropriate: 60.4% to 79.5%; inappropriate: 13% to 5.2%; p < 0.0001), internal medicine/family practice (appropriate: 51.1% to 70.4%; inappropriate: 20.2% to 12.5%; p < 0.0001), emergency medicine (appropriate: 83.6% to 91.6%; inappropriate: 9.1% to 0.6%; p < 0.0001), and other (appropriate: 61.1% to 83.2%; inappropriate: 18.6% to 5.9%; p < 0.0001).
Conclusions Application of a systematic CQI and emphasis on possible loss of coverage were associated with a significant improvement in the proportion of CCTA examinations meeting AUC across referring physician specialties.
This study was funded by Blue Cross/Blue Shield/Blue Care Network of Michigan. Dr. Ananthasubramaniam has received grant support, Astellas Pharma Global Development, Inc., GE Healthcare, Trovis Pharmaceuticals, and GlaxoSmithKline; speakers bureau/honoraria from Astellas Pharma, Inc. and Lantheus Medical Imaging; and is a consultant/advisory board member for Lantheus Medical Imaging and Astellas Pharma. Dr. Raff has received grant support from Siemens Healthcare. Dr. Share receives salary support from Blue Cross/Blue Shield/Blue Care Network of Michigan. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received March 20, 2012.
- Revision received May 16, 2012.
- Accepted June 5, 2012.
- American College of Cardiology Foundation