Clinical trial NCT01968642: Education and Feedback Intervention to Reduce Inappropriate Transthoracic Echocardiograms
Official title: Educational Intervention to Reduce Outpatient Inappropriate Transthoracic Echocardiograms Ordered by Attending Physicians
Study type: INTERVENTIONAL
Overall status: UNKNOWN
Phase: NA
Conditions: Inappropriate and Appropriate Transthoracic Echocardiograms
Keywords: Transthoracic echocardiograms
Appropriate Use Criteria
Medical Education
Lead sponsor: Massachusetts General Hospital
Sponsor class: OTHER
First posted: 2013-10-24
Enrollment: 150
Sex: ALL
Standard ages: CHILD
ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: HEALTH_SERVICES_RESEARCH

Brief summary: 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: 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.

Eligibility criteria: Inclusion Criteria:

* Cardiology Attending physicians at Massachusetts General Hospital
* Primary care physicians at Massachusetts General Hospital

Exclusion Criteria:

* Physicians-in-training

Primary outcomes:
measure: Rate of Inappropriate transthoracic echocardiograms
timeFrame: 12 months
Secondary outcomes:
measure: Rate of Appropriate transthoracic echocardiograms
timeFrame: 12 months
Other outcomes:
measure: Clinical reasons for appropriate and inappropriate transthoracic echocardiograms
timeFrame: 12 months
Locations:
city: Boston
country: United States
facility: Massachusetts General Hospital
state: Massachusetts
Study officials:
affiliation: Massachusetts General Hospital
name: Rory B Weiner, MD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Bhatia RS, Milford CE, Picard MH, Weiner RB. An educational intervention reduces the rate of inappropriate echocardiograms on an inpatient medical service. JACC Cardiovasc Imaging. 2013 May;6(5):545-55. doi: 10.1016/j.jcmg.2013.01.010. Epub 2013 Apr 10.
citation: Dudzinski DM, Bhatia RS, Mi MY, Isselbacher EM, Picard MH, Weiner RB. Effect of Educational Intervention on the Rate of Rarely Appropriate Outpatient Echocardiograms Ordered by Attending Academic Cardiologists: A Randomized Clinical Trial. JAMA Cardiol. 2016 Oct 1;1(7):805-812. doi: 10.1001/jamacardio.2016.2232.