Education and Feedback Intervention to Reduce Inappropriate Transthoracic Echocardiograms

NCT ID: NCT01968642

Last Updated: 2014-02-11

Basic Information

• Recruitment Status: UNKNOWN
• Clinical Phase: NA
• Total Enrollment: 150 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2013-11-30
• Study Completion Date: 2014-10-31

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.

Conditions

Inappropriate and Appropriate Transthoracic Echocardiograms

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: HEALTH_SERVICES_RESEARCH
• Blinding Strategy: SINGLE

Study Groups

Educational Intervention

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.

Group Type: EXPERIMENTAL

Educational Intervention

Intervention Type: BEHAVIORAL

Control Group

Attending physicians in the control arm will have their echocardiogram orders tracked and classified, but will not receive any feedback on their ordering behavior.

Group Type: NO_INTERVENTION

No interventions assigned to this group

Interventions

Educational Intervention

Intervention Type: BEHAVIORAL

Eligibility Criteria

Inclusion Criteria

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

Exclusion Criteria

• Physicians-in-training

• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Massachusetts General Hospital

OTHER

Sponsor Role: lead

Responsible Party

Rory Weiner, MD

Principal Investigator

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Rory B Weiner, MD

Role: PRINCIPAL_INVESTIGATOR

Massachusetts General Hospital

Locations

Massachusetts General Hospital

Boston, Massachusetts, United States

Site Status: RECRUITING

Countries

United States

Central Contacts

Rory B Weiner, MD

Role: CONTACT

rweiner@partners.org

617-724-0358

Facility Contacts

Rory B Weiner, MD

Role: primary

rweiner@partners.org

617-724-0358

References

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.

Reference Type: BACKGROUND

PMID: 23582360 (View on PubMed)

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.

Reference Type: DERIVED

PMID: 27547895 (View on PubMed)

Other Identifiers

2011P001779 AME3

Identifier Type: -

Identifier Source: org_study_id