Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada; Peter Munk Cardiac Centre of the University Health Network, University of Toronto, Toronto, Ontario, Canada.
Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada; Department of Family and Community Medicine, University of Toronto, Women's College Hospital, Toronto, Ontario, Canada.
J Am Coll Cardiol. 2017 Aug 29;70(9):1135-1144. doi: 10.1016/j.jacc.2017.06.065.
Appropriate use criteria (AUC) have defined transthoracic echocardiogram (TTE) indications for which there is a clear lack of benefit as rarely appropriate (rA).
This study sought to investigate the impact of an AUC-based educational intervention on outpatient TTE ordering by cardiologists and primary care providers.
The authors conducted a prospective, investigator-blinded, multicenter, randomized controlled trial of an AUC-based educational intervention aimed at reducing rA outpatient TTEs. The study was conducted at 8 hospitals across 2 countries. The authors randomized cardiologists and primary care providers to receive either intervention or control (no intervention). The primary outcome measure was the proportion of rA TTEs.
One hundred and ninety-six physicians were randomized, and 179 were included in the analysis. From December 2014 to April 2016, the authors assessed 14,697 TTEs for appropriateness, of which 99% were classifiable using the 2011 AUC. The mean proportion of rA TTEs was significantly lower in the intervention versus the control group (8.8% vs. 10.1%; odds ratio [OR]: 0.75; 95% confidence interval [CI]: 0.57 to 0.99; p = 0.039). In physicians who ordered, on average, at least 1 TTE per month, there was a significantly lower proportion of rA TTEs in the intervention versus the control group (8.6% vs. 11.1%; OR: 0.76; 95% CI: 0.57 to 0.99; p = 0.047). There was no difference in the TTE ordering volume between the intervention and control groups (mean 77.7 ± 89.3 vs. 85.4 ± 111.4; p = 0.83).
An educational intervention reduced the number of rA TTEs ordered by attending physicians in a variety of ambulatory care environments. This may prove to be an effective strategy to improve the use of imaging. (A Multi-Centered Feedback and Education Intervention Designed to Reduce Inappropriate Transthoracic Echocardiograms [Echo WISELY]; NCT02038101).
适当使用标准（AUC）已经确定了经胸超声心动图（TTE）的适应证，这些适应证很少有明确的获益，因此被归类为不适当（rA）。
本研究旨在探讨基于 AUC 的教育干预对心脏病专家和初级保健提供者门诊 TTE 开具的影响。
作者进行了一项前瞻性、研究者盲法、多中心、随机对照试验，对基于 AUC 的教育干预措施进行了研究，旨在减少不适当的门诊 TTE。该研究在 2 个国家的 8 家医院进行。作者将心脏病专家和初级保健提供者随机分配接受干预或对照组（无干预）。主要结局指标是 rA TTE 的比例。
共随机分配了 196 名医生，其中 179 名医生纳入分析。2014 年 12 月至 2016 年 4 月，作者评估了 14697 例 TTE 的适宜性，其中 99%可使用 2011 年 AUC 进行分类。与对照组相比，干预组 rA TTE 的比例显著降低（8.8%对 10.1%；优势比[OR]：0.75；95%置信区间[CI]：0.57 至 0.99；p=0.039）。在平均每月至少开具 1 次 TTE 的医生中，干预组 rA TTE 的比例明显低于对照组（8.6%对 11.1%；OR：0.76；95% CI：0.57 至 0.99；p=0.047）。干预组和对照组 TTE 开具量无差异（平均 77.7±89.3 对 85.4±111.4；p=0.83）。
教育干预减少了各种门诊环境中主治医生开具的 rA TTE 数量。这可能是一种改善影像学使用的有效策略。（一项旨在减少不适当经胸超声心动图的多中心反馈和教育干预[明智使用超声心动图（Echo WISELY）]；NCT02038101）。
