Education and Feedback Intervention to Reduce Inappropriate Transthoracic Echocardiograms

Study Overview
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Brief Summary
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The utilization of transthoracic echocardiography in the United States has been increasing. This has resulted in increased costs to the healthcare system. In an effort to curb excessive utilization of this technology, the American College of Cardiology created Appropriate Use Criteria to help guide clinicians to use this diagnostic imaging modality more appropriately. The investigators previously showed that an educational intervention can reduce the rate of inappropriate echocardiograms ordered by physicians-in-training. It is unknown if such an intervention would be successful in attending, staff level of physicians. The investigators hypothesize that an educational and feedback intervention will reduce the rate of inappropriate outpatient transthoracic echocardiograms ordered by staff cardiologists and internal medicine physicians.

Detailed Description
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In response to increasing utilization of echocardiography, the American Society of Echocardiography along with the American College of Cardiology released Appropriate Use Criteria (AUC) for transthoracic echocardiography (TTE) in 2007, and these have been subsequently updated in 2011. TTE ordering patterns have been evaluated and have shown that between 15-30% of TTE ordered are inappropriate. The highest rate of inappropriate TTE is found in the outpatient environment, where routine or surveillance studies are common. These studies have also found that internists and cardiologists order the majority of TTE. The investigators previously documented that an AUC-based educational and feedback intervention reduced the rate of inappropriate TTE by cardiology and internal medicine physicians-in-training. Whether this type of intervention can improve TTE ordering of attending level physicians is not known.

Official Title
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Educational Intervention to Reduce Outpatient Inappropriate Transthoracic Echocardiograms Ordered by Attending Physicians

Conditions
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Inappropriate and Appropriate Transthoracic Echocardiograms

Intervention / Treatment
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* Behavioral: Educational Intervention


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Cardiology Attending physicians at Massachusetts General Hospital Primary care physicians at Massachusetts General Hospital Exclusion Criteria: Physicians-in-training
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Educational Intervention<br>Attending physicians in the intervention arm will receive the following multi-faceted educational intervention on transthoracic echocardiogram appropriateness: 1) a lecture at the beginning of the study period, which describes Appropriate USe Criteria (AUC) and highlights common clinical scenarios for which outpatient echocardiograms are ordered, 2) an electronic pocket cared via email that provides tips on appropriate ordering of echocardiograms, and 3) an individualized monthly feedback report that categorizes echocardiograms ordered over the preceding month. The feedback report will contain the number of echocardiograms ordered during the month and how many are classified as appropriate, inappropriate, or uncertain based on the 2011 AUC. | Behavioral: Educational Intervention<br> <br> |
| No Intervention: Control Group<br>Attending physicians in the control arm will have their echocardiogram orders tracked and classified, but will not receive any feedback on their ordering behavior. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Rate of Inappropriate transthoracic echocardiograms | Rate of inappropriate echocardiograms determined from a review of the electronic medical record. | 12 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Rate of Appropriate transthoracic echocardiograms | Rate of appropriate transthoracic echocardiograms determined from a review of the electronic medical record. | 12 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Transthoracic echocardiograms, Appropriate Use Criteria, Medical Education