Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Am J Med. 2011 Aug;124(8):740-6. doi: 10.1016/j.amjmed.2011.03.030.
The impact of the 2007 American College of Cardiology Foundation Transthoracic Echocardiography Appropriateness Criteria on trends in appropriateness is unknown. Therefore, we sought to identify the appropriateness of outpatient transthoracic echocardiography pre- and postpublication of this document.
The 2007 Appropriateness Criteria were used to classify outpatient echocardiographic studies at an academic medical center during October 2000 and October 2008. The patient's electronic medical record was used to identify echocardiographic indication and appropriateness.
From October 2000 to October 2008, there was an 85% increase in outpatient echocardiographic volume. Using the Appropriateness Criteria, there was no significant change in inappropriate referrals (13% and 15%, P=.58). Sixty-five studies (12%) were referred for indications "not addressed" by the document, with an increase (7% to 15%, P=.012) from 2000 to 2008. In a second analysis, incorporating the 2008 Valve Guidelines, an increase was demonstrated in the total number of studies that could be classified, but there was no significant change in the proportion of inappropriate referrals (P=.50). There remained a significant increase (3% to 10%, P=.009) in the proportion of indications "not addressed" by either guideline.
From October 2000 to October 2008, we experienced a near doubling of outpatient echocardiographic volume, with no significant change in the percent of inappropriate referrals despite interim publication of the Appropriateness Criteria document. In addition, there was an increase in echocardiographic referrals for "not addressed" indications. Future efforts are needed both to refine the Appropriateness Criteria to include unaddressed indications and to promote its effective implementation.
美国心脏病学会基金会 2007 年经胸超声心动图适宜性标准对适宜性趋势的影响尚不清楚。因此，我们试图确定在该文件发表前后，门诊经胸超声心动图的适宜性。
在学术医疗中心，2007 年适宜性标准被用于分类 2000 年 10 月和 2008 年 10 月的门诊超声心动图检查。患者的电子病历用于识别超声心动图的适应证和适宜性。
从 2000 年 10 月至 2008 年 10 月，门诊超声心动图量增加了 85%。使用适宜性标准，不适当的转诊没有明显变化（分别为 13%和 15%，P=0.58）。有 65 项研究（12%）因该文件未涵盖的适应证而被转诊，从 2000 年到 2008 年有所增加（从 7%增加到 15%，P=0.012）。在第二次分析中，纳入 2008 年瓣膜指南后，可分类的研究总数增加，但不适当转诊的比例没有显著变化（P=0.50）。两种指南都未涵盖的适应证的比例仍然显著增加（从 3%增加到 10%，P=0.009）。
从 2000 年 10 月至 2008 年 10 月，我们经历了门诊超声心动图量的近两倍增长，尽管中间发表了适宜性标准文件，但不适当转诊的比例没有显著变化。此外，对于“未涉及”的适应证，超声心动图的转诊量有所增加。未来需要努力改进适宜性标准，以包括未涉及的适应证，并促进其有效实施。
