Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN, USA.
J Nucl Cardiol. 2012 Apr;19(2):285-90. doi: 10.1007/s12350-011-9459-8.
There is limited published data comparing the appropriateness use criteria for SPECT MPI with the specialty of the ordering provider. The aim of this study was to examine if the specialty of the ordering provider affected either the ordering indication or the appropriateness of stress SPECT MPI.
The ordering provider’s specialty was compared with the study indication and appropriateness rating. There were modest but significant differences in general indications by specialty. For example, the Emergency Department group ordered fewer studies in asymptomatic patients (3% compared to 14%-23% in the other four referral groups). In contrast, 43% of the studies ordered by Cardiovascular Division physicians and 39% of the studies ordered by the Registered Nurse group were on post-revascularization patients, compared to 23%-31% of those ordered by the other three groups. Overall appropriateness classification did not differ among the five specialty groups (P 5 0.19).
In a clinical practice where pre-operative testing using SPECT is infrequent,the rate of inappropriate studies was similar for all ordering providers. Quality improvement efforts in similar practices will likely require a broad educational focus on all ordering providers.
目前发表的关于 SPECT MPI 适宜性使用标准的相关数据有限，且这些数据与开单医生的专业相关性不大。本研究旨在探讨开单医生的专业是否会影响 SPECT MPI 的开单指征和适宜性。
我们将开单医生的专业与检查指征和适宜性评分进行了比较。不同专业之间的一般指征存在一定差异，虽然这种差异的幅度较小，但有统计学意义。例如，急诊科开单的检查中，无症状患者的比例较少（3%，而其他四个转诊科室的比例为 14%-23%）。相比之下，心血管科医生开单的检查中，有 43%的检查为血运重建术后患者，注册护士开单的检查中有 39%为血运重建术后患者，而其他三个科室的开单比例为 23%-31%。五个专业组之间的整体适宜性分类无显著差异（P 5 0.19）。
在 SPECT 术前检查不常见的临床实践中，所有开单医生的不适宜检查比例相似。在类似的实践中，质量改进工作可能需要广泛关注所有的开单医生。
