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Related Experiment Videos

Feedback intervention to reduce routine electrocardiogram use in primary care.

Randall S Stafford1

  • 1Primary Care Operations Improvement Team, Institute for Health Policy, Massachusetts General Hospital, Harvard Medical School, Boston, Mass, USA. rstafford@stanford.edu

American Heart Journal
|June 11, 2003
PubMed
Summary

Physician feedback successfully reduced unnecessary electrocardiogram (ECG) use and practice variation. This intervention shows promise for improving evidence-based test ordering in primary care settings.

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Area of Science:

  • Health Services Research
  • Clinical Practice Improvement
  • Preventive Cardiology

Background:

  • Physicians often order non-essential diagnostic tests, including screening electrocardiograms (ECGs).
  • Effective strategies to promote evidence-based test ordering are not well-established.
  • This study evaluated an intervention to reduce screening ECG use and its variability.

Purpose of the Study:

  • To assess the impact of a feedback intervention on screening electrocardiogram (ECG) ordering rates.
  • To evaluate the intervention's effect on practice variation among primary care providers.
  • To determine if the intervention leads to more evidence-based test ordering.

Main Methods:

  • A non-randomized pre-post intervention trial involving 117 primary care providers.

Related Experiment Videos

  • Providers received periodic, case-mix-adjusted peer comparisons of their screening ECG use over a 9-month intervention period.
  • Data on ECG ordering were tracked using computerized billing systems before, during, and after the intervention.

    • Main Results:

    • Screening ECGs were ordered in 4.6% of visits pre-intervention, decreasing to 3.5% during and 2.8% post-intervention (P <.001).
    • Substantial provider variation in ECG ordering (CV 101.6%) significantly narrowed post-intervention (CV 92.5%).
    • Multivariate analysis confirmed a persistent positive impact of the feedback intervention.

    Conclusions:

    • Feedback interventions can effectively reduce the use of non-essential diagnostic tests like screening ECGs.
    • This approach successfully decreased practice variation in test ordering.
    • The strategy may be applicable to modifying other physician behaviors that deviate from evidence-based guidelines.