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The impact of individual variation analysis on myocardial perfusion imaging utilization within a hospitalist group
Hacho B Bohossian1, Allison W Park, Christina Holcroft
1Division of Hospital Medicine, Newton-Wellesley Hospital, Newton, Massachusetts.
Background:
Increased recognition of ionizing radiation risks has placed an emphasis on the appropriate use of myocardial perfusion imaging (MPI). Hospitalists frequently order MPI in the evaluation of chest pain and are thus at the forefront of its inpatient utilization.
Methods:
We collected baseline figures for a group MPI rate (March 2010-February 2011) as well as individual MPI rates for hospitalists caring for cardiac floor patients at a community teaching hospital. We performed a 2-part intervention; we presented the individual MPI rate data back to the hospitalist division and carried out longitudinal educational efforts on MPI appropriateness criteria. We then calculated the group MPI utilization rate for 3 postintervention periods (March 2011-February 2012, March 2012-February 2013, and March 2013-February 2014) and the MPI rate for the subgroup of cardiac floor patients. Finally, we calculated the percentage of inappropriately performed stress tests before and after our intervention.
Results:
Group MPI rate declined from 6.1% to 5.0% in the first year after our intervention (P = 0.009); a decrease was maintained a year later-MPI rate 4.9% (P = 0.004)-and became even more pronounced 2 years later-MPI rate 3.9% (P < 0.0001). The MPI rate for the subgroup of patients on the cardiac floor similarly decreased from 8.0% to 6.7% (P = 0.039). Finally, we report a particularly encouraging and significant trend of a 46% postintervention decrease (from 16.5% to 9%, P = 0.034) in the proportion of inappropriate stress tests ordered.
Conclusions:
Analyzing individual ordering rates and combining them with educational efforts was an effective strategy for impacting MPI utilization in the hospitalist group studied.
Insights
Providing hospitalists with individual myocardial perfusion imaging (MPI) rates and education significantly reduced MPI utilization and inappropriate stress tests. This strategy effectively improved appropriate MPI use in inpatient settings.
Area of Science:
- Cardiology
- Radiology
- Healthcare Management
Background:
- Growing awareness of ionizing radiation risks necessitates judicious use of myocardial perfusion imaging (MPI).
- Hospitalists play a key role in ordering MPI for chest pain evaluations, influencing inpatient utilization patterns.
Purpose of the Study:
- To assess the impact of feedback on individual MPI ordering rates and educational interventions on MPI utilization among hospitalists.
- To evaluate the change in the proportion of inappropriately performed stress tests following the intervention.
Main Methods:
- Collected baseline MPI rates for a hospitalist group and cardiac floor patients.
- Implemented a two-part intervention: individual rate feedback and educational sessions on MPI appropriateness.
- Monitored MPI utilization rates for three years post-intervention and calculated changes in inappropriate stress test proportions.
Main Results:
- Group MPI rate decreased significantly from 6.1% to 3.9% over two years post-intervention (P < 0.0001).
- MPI rate for cardiac floor patients also decreased from 8.0% to 6.7% (P = 0.039).
- A significant 46% reduction in inappropriate stress tests was observed, decreasing from 16.5% to 9% (P = 0.034).
Conclusions:
- Providing individual MPI utilization data combined with targeted education is an effective strategy to reduce MPI use.
- This approach successfully improved the appropriate utilization of MPI within the studied hospitalist group.
