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Related Experiment Videos

Variation in routine electrocardiogram use in academic primary care practice.

R S Stafford1, B Misra

  • 1Stanford Center for Research in Disease Prevention, 1000 Welch Rd, Palo Alto, CA 94304, USA. rstafford@stanford.edu

Archives of Internal Medicine
|November 9, 2001
PubMed
Summary

Routine electrocardiogram (ECG) ordering in primary care varies significantly between providers, unrelated to patient factors. This highlights a need for standardized guidelines for screening ECGs to reduce nonclinical variations.

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Area of Science:

  • Cardiology
  • Primary Care Medicine
  • Health Services Research

Background:

  • A lack of consensus exists regarding routine electrocardiogram (ECG) ordering in primary care settings.
  • This ambiguity may lead to nonclinical variations in ECG utilization among healthcare providers.

Purpose of the Study:

  • To investigate the extent of nonclinical variations in routine electrocardiogram (ECG) ordering among primary care providers.
  • To identify patient and provider characteristics associated with ECG ordering.

Main Methods:

  • Utilized computerized billing data from 10 internal medicine group practices (October 1996 - September 1997).
  • Included 69,921 patients and 190,238 visits, excluding patients with known cardiac disease or symptoms.
  • Adjusted ECG ordering rates for patient demographics and diagnoses; logistic regression identified predictors.

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Main Results:

  • Electrocardiograms were ordered in 4.4% of visits for patients without reported cardiac disease.
  • Adjusted ECG ordering rates varied widely: 0.8%-8.6% across practices and 0.0%-24% among individual providers.
  • Older patient age, male sex, comorbidities, Medicare payment, older male providers, and providers billing for ECG interpretation were significant predictors.

Conclusions:

  • Patient characteristics do not explain the observed variations in ECG ordering.
  • Significant nonclinical variations in screening ECG ordering necessitate the development of greater consensus and standardized guidelines in primary care.