Related Experiment Video
Updated: Mar 27, 2026
Assessing Cardiac Reprogramming using High Content Imaging Analysis
Published on: October 26, 2020
Effectiveness of Quality Improvement Interventions at Reducing Inappropriate Cardiac Imaging: A Systematic Review and
Dipayan Chaudhuri1, Alison Montgomery1, Karen Gulenchyn1
1Michael G. DeGroote School of Medicine (D.C.), Departments of Medicine (A.M., K.G., P.J.), Radiology (A.M., K.G., P.J.), Faculty of Science (M.M.), and Population Health Research Institute (P.J.), McMaster University, Hamilton, Ontario, Canada.
Background:
Between 5% and 25% of cardiac imaging tests are performed for inappropriate indications. Studies have examined the impact of appropriate use criteria-based quality improvement initiatives on inappropriate testing, but they have not been systematically evaluated.
Methods And Results:
We performed a systematic review of studies evaluating quality improvement initiatives aimed at reducing inappropriate cardiac imaging. The primary outcome was the proportion of inappropriate tests based on appropriate use criteria. Studies were analyzed using a random effects meta-analysis model, and heterogeneity was examined using subgroup analyses. We identified 6 observational studies and 1 randomized control trial. Most interventions (n=6) had a formal education component, and 5 included a mechanism for physician audit and feedback. Although these interventions were associated with lower odds of inappropriate testing (odds ratio, 0.44 [95% confidence interval, 0.32-0.61]; P<0.001), significant heterogeneity was observed (I(2)=70%), which was best explained by the utilization of physician audit and feedback. Interventions that employed physician audit and feedback were associated with significantly lower odds of inappropriate testing (odds ratio, 0.36 [95% confidence interval, 0.31-0.41]; P<0.001; I(2)=0%), whereas those that did not had no effect (odds ratio, 0.89 [95% confidence interval, 0.61-1.29]; P=0.51; I(2)=0%; P value for difference <0.001). All studies had potential sources of bias that could have affected the observed estimates.
Conclusions:
Interventions using physician audit and feedback are associated with lower odds of inappropriate cardiac testing. Further research is needed to evaluate a greater diversity of intervention types, with improved study designs.
Insights
Physician audit and feedback significantly reduce inappropriate cardiac imaging tests. Quality improvement initiatives incorporating this feedback show the most promise for optimizing test utilization.
Area of Science:
- Cardiology
- Health Services Research
- Quality Improvement
Background:
- 5-25% of cardiac imaging tests are performed for inappropriate reasons.
- Previous studies explored quality improvement initiatives but lacked systematic evaluation.
Purpose of the Study:
- To systematically evaluate quality improvement initiatives aimed at reducing inappropriate cardiac imaging tests.
Main Methods:
- Systematic review and meta-analysis of 6 observational studies and 1 RCT.
- Primary outcome: proportion of inappropriate tests based on appropriate use criteria.
- Subgroup analyses to examine heterogeneity.
Main Results:
- Interventions with physician audit and feedback significantly reduced inappropriate cardiac testing (OR 0.36).
- Interventions without audit and feedback showed no significant effect (OR 0.89).
- Significant heterogeneity was observed, primarily explained by audit and feedback.
Conclusions:
- Physician audit and feedback are effective in lowering inappropriate cardiac testing rates.
- Further research with diverse interventions and improved designs is warranted.
