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Impact of an educational program on bilateral heart catheterization practice patterns

M Malach¹, P J Imperato, R P Nenner

¹New York University School of Medicine, New York, USA.

American Journal of Medical Quality : the Official Journal of the American College of Medical Quality

|December 2, 1998

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An educational intervention significantly reduced routine right heart catheterizations (RHC) in coronary artery disease patients, demonstrating successful quality improvement in cardiovascular care.

Area of Science:

Cardiovascular Medicine
Health Services Research
Quality Improvement

Background:

Right heart catheterization (RHC) for coronary artery disease (CAD) has faced scrutiny regarding its necessity.
Preliminary data showed significant inter-hospital variation in RHC performance among Medicare and Medicaid patients, suggesting routine use.

Purpose of the Study:

To assess the impact of an educational intervention on the frequency of RHC in patients with CAD.
To reduce non-medically indicated RHC procedures.

Main Methods:

Analysis of Medicare and Medicaid claims data for bilateral catheterizations before and after a 4-year educational intervention program.
The intervention involved disseminating guidelines and conducting educational meetings with 53 catheterization laboratories.

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Main Results:

Baseline data (1992) showed 18.4% of labs performed RHC routinely (70-100%) on CAD patients.
Following the intervention, RHC rates among Medicare patients decreased from 30.5% (1992) to 17.4% (1996).
Rates for both Medicare and Medicaid patients in high-performing labs dropped dramatically, e.g., Medicare from 89.1% to 31.6%.

Conclusions:

Many previously performed RHC procedures in CAD patients were routine and not medically indicated.
The study demonstrates the effectiveness of collaborative quality improvement efforts between providers and peer review organizations in reducing unnecessary procedures.