Appropriateness vs value: Echocardiography in primary care

Area of Science:

• Cardiology
• Health Services Research
• Diagnostic Imaging

Background:

• Rising healthcare spending in the US is a systemic issue.
• Overutilization of diagnostic tests, including echocardiography, contributes to increased healthcare costs.
• Primary care physicians frequently order echocardiograms, a test with increasing utilization rates.

Purpose of the Study:

• To evaluate the impact of echocardiography on patient management when ordered by primary care physicians in low-risk settings.
• To assess the appropriateness of echocardiogram utilization in primary care based on established guidelines.

Main Methods:

• A retrospective review of 239 echocardiograms ordered by primary care physicians between January 1, 2014, and December 31, 2014.
• Data extracted included indication, results, and changes in medical management.
• Appropriateness was assessed using the appropriate use criteria for echocardiography.

Main Results:

• Approximately 97% of echocardiograms were deemed appropriate based on the criteria.
• Only 52 out of 239 patients (21.8%) had abnormalities detected.
• A mere 6 patients (2.5%) experienced a change in management directly related to the echocardiogram findings and suspected diagnosis.

Conclusions:

• Despite appropriate ordering, echocardiography in low-likelihood settings has minimal impact on cardiac therapy.
• Developing comprehensive guidelines to identify patient risk stratification is crucial for optimizing diagnostic test value.
• Educational interventions and feedback on ordering behaviors are recommended to improve the use of diagnostic testing.