PDF(Pubmed)
Abstract：
Background Appropriate Use Criteria (AUC) for echocardiography are a useful tool to deliver quality healthcare. Our quality-based interventional study was designed to assess the trends in appropriate utilization rates for echocardiography in our institution and improve adherence to the AUC criteria for transthoracic echocardiograms (TTE). Methodology A prospective, time series analysis was conducted at the Upstate University Hospital for the months of July 2019 and August 2020. A chart analysis was performed on 620 consecutive inpatients who underwent TTE for the month of July 2019. We assessed the trends of the appropriate ordering of TTEs. We then updated our order form incorporating the 42 most common appropriate indications. A post-intervention chart analysis was performed on all inpatient TTEs ordered for the month of August 2020 (n = 410). The appropriateness of the TTE for the entire group was determined based on the true indication per chart review. The primary outcome was the proportion of appropriate and inappropriate TTEs ordered. Secondary outcomes included assessing for concordance between the indication on the order requisition form and by chart review. A p-value <0.05 was considered significant. Results Using the 2011 AUC for the entire group, 81% of the pre-intervention TTEs and 79.5% of the post-intervention TTEs were appropriate (p = 0.55). There was a statistically significant reduction in the number of discordant TTE orders before and after the intervention (p < 0.01). In addition, we noted increased appropriateness of TTEs in the concordant group both pre and post-intervention. Conclusions Our study demonstrates a significant increase in the concordance between the TTE order sheet and actual indication per chart review with the intervention. This can translate into improved scanning and physician reading quality and time, thereby increasing focus on areas of interest according to the true indication. There was no significant increase in the appropriate TTEs ordered.
摘要：
背景技术超声心动图的适当使用标准(AUC)是提供高质量医疗保健的有用工具。我们基于质量的介入研究旨在评估本机构超声心动图适当利用率的趋势，并提高对经胸超声心动图（TTE）AUC标准的依从性。方法论A前瞻性，时间序列分析在2019年7月和2020年8月在Upstate大学医院进行。对2019年7月接受TTE的620名连续住院患者进行了图表分析。我们评估了TTE适当排序的趋势。然后，我们更新了订单表格，其中包含42种最常见的适当适应症。对2020年8月订购的所有住院TTE进行干预后图表分析（n=410）。整个组的TTE的适当性基于每个图表审查的真实适应症来确定。主要结果是订购的适当和不适当TTE的比例。次要结果包括评估订单申请表上的指示与图表审查之间的一致性。P值<0.05被认为是显著的。结果使用整个组的2011年AUC，81%的干预前TTEs和79.5%的干预后TTEs是合适的(p=0.55)。干预前后不一致的TTE顺序的数量有统计学上的显着减少（p<0.01）。此外,我们注意到一致组干预前后的TTEs适当性增加.结论我们的研究表明，TTE订单与干预措施对每个图表审查的实际适应症之间的一致性显着提高。这可以转化为改进的扫描和医生阅读质量和时间，从而根据真正的指示增加对感兴趣领域的关注。订购的适当TTE没有显着增加。
