Abstract
Background
Although differences in the rate of utilization of invasive cardiac procedures between Veterans Affairs (VA) hospitals and other health care systems are present, noninvasive cardiac imaging use pattern has not been well studied. We evaluated the ability of the updated appropriateness use criteria (AUC) to determine utilization patterns of myocardial perfusion imaging (MPI) and compare use between an academic practice and a VA.
Methods
One-hundred fifty stress/rest MPI studies in an academic practice and 150 at a VA hospital were retrospectively reviewed using the hierarchical approach published in the 2009 AUC.
Results
Less than 1% of studies were unclassified. A higher percentage of MPI were requested for inappropriate reason at the VA, although this difference was not statistically significant (P = .248). In the VA, non-physicians requested significantly more inappropriate studies than physicians (26.8% vs 20.1%; P < .048). Within the academic practice non-cardiologists referred more patients for inappropriate indications than cardiologists (23.9% vs 10.1%; P = .001). Five most common inappropriate indications accounted for the vast majority of inappropriately requested MPI (77%).
Conclusions
The revised 2009 AUC allow for near complete categorization of appropriateness in testing. Differences between institutions and provider types were noted and areas for improved utilization were identified.
Similar content being viewed by others
References
Lucas FL, DeLorenzo MA, Siewers AE, Wennberg DE. Temporal trends in the utilization of diagnostic testing and treatments for cardiovascular disease in the United States, 1993-2001. Circulation 2006;113:374-9.
Gibbons R, Eckel R, Jacobs AK. The utilization of cardiac imaging. Circulation 2006;113:1715-6.
Hendel RC, et al. ACCF/ASNC/ACR/AHA/ASE/SCCT/SCMR/SNM 2009 Appropriate use criteria for cardiac radionuclide imaging: a report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, the American Society of Nuclear Cardiology, the American College of Radiology, the American Heart Association, the American Society of Echocardiography, the Society of Cardiovascular Computed Tomography, the Society for Cardiovascular Magnetic Resonance, and the Society of Nuclear Medicine. Circulation 2009;199:e561-e587.
Mehta R, et al. Evaluation of the American College of Cardiology Foundation/American Society of Nuclear Cardiology appropriateness criteria for SPECT myocardial perfusion imaging. J Nucl Cardiol 2008;15:337-44 (epub 2008 April 16).
Gibbons RJ, et al. Application of appropriateness criteria to stress single-photon emission computed tomography sestamibi studies and stress echocardiograms in an academic medical center. J Am Coll Cardiol 2008;51:1283-9.
Hendel RC, et al. A multicenter assessment of the use of single-photon emission computed tomography myocardial perfusion imaging with appropriateness criteria. J Am Coll Cardiol 2010;55:156-62.
Carryer DJ, Hodge DO, Miller TD, Askew JW, Gibbons RJ. Application of appropriateness criteria to stress single photon emission computed tomography sestamibi studies: A comparison of the 2009 revised appropriateness criteria to the 2005 original criteria. Am Heart J 2010;160:244-9.
Jha AK, et al. Effect of the transformation of the Veterans Affairs health care system on the quality of care. N Engl J Med 2003;348:2218-27.
Elmore JG, et al. Does litigation influence medical practice? The influence of community radiologists’ medical malpractice perceptions and experience on screening mammography. Radiology 2005;236:37-46.
Hooker RS. Physician assistants and nurse practitioners: The United States experience. Med J Aust 2006;185:4-7.
Albert NM, et al. Outpatient cardiology practices with advanced practice nurses and physician assistants provide similar delivery of recommended therapies (findings from IMPROVE HF). Am J Cardiol 2010;105:1773-9.
Krasuski RA, et al. Trained and supervised physician assistants can safely perform diagnostic cardiac catheterization with coronary angiography. Catheter Cardiovasc Interv 2003;59:157-60.
Appropriateness use criteria for radionuclide imaging for i-phones. http://www.astellasapps.com/. Accessed September 18, 2010.
Imaging in FOCUS: RNI Improvement Tool on Cardiosource. http://www.cardiosource.org/Science-And-Quality/Quality-Programs/Imaging-in-FOCUS/RNI-Decision-Support-Tool.aspx.
Hooker RS. A cost analysis of physician assistants in primary care. J Am Acad Phys Assist 2002;15:39-42.
Koh AS, Flores JL, Keng FY, et al. Evaluation of the ACCF/ASNC appropriateness criteria for SPECT myocardial perfusion imaging in an Asian tertiary cardiac center. J Nucl Cardiol 2011;18:324-30 (epub 2010 November 24).
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Nelson, K.H., Willens, H.J. & Hendel, R.C. Utilization of radionuclide myocardial perfusion imaging in two health care systems: Assessment with the 2009 ACCF/ASNC/AHA appropriateness use criteria. J. Nucl. Cardiol. 19, 37–42 (2012). https://doi.org/10.1007/s12350-011-9467-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12350-011-9467-8