Audits, Feedback Lower Odds of Inappropriate Cardiac Imaging

Physician audits and feedback related to quality improvement interventions are associated with lower odds of inappropriate cardiac testing, according to a study published in Circulation: Cardiovascular Quality and Outcomes.

Researchers from Canada performed a systematic review to examine the literature for current evidence supporting quality improvement initiatives that would improve the use of noninvasive cardiac tests, the impact of the interventions, and the impact of specific components within the initiatives.

The primary outcome of the study was the proportion of inappropriate tests based on appropriate use criteria. Inappropriate tests were tests that were rarely effective in directing patient management, or if the advantages of the benefits and risks were not clear. Conversely, if the tests were effective in directing patient care and their benefits outweighed the risks, they were deemed appropriate.

The search located six observational studies and one randomized control trial (13,012 study participants) that fit the researchers’ criteria:[[{"type":"media","view_mode":"media_crop","fid":"44795","attributes":{"alt":"","class":"media-image media-image-right","id":"media_crop_850154462163","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"5043","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 107px; width: 160px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":"©hywards/Shutterstock.com","typeof":"foaf:Image"}}]]

• Randomized control trials or observational studies

• Cardiac testing with either single photon emission CT myocardial perfusion imaging, echocardiography, cardiac magnetic resonance, or cardiac CT angiography

• Use of a quality improvement intervention aimed at reducing inappropriate tests or increasing appropriate tests

• Outcomes measured using appropriate use criteria (AUC)

According to the study results, six interventions had a formal education component and five had a mechanism for physician audit and feedback.

“Although these interventions were associated with lower odds of inappropriate testing, significant heterogeneity was observed, which was best explained by the utilization of physician audit and feedback,” the authors wrote. “Interventions that employed physician audit and feedback were associated with significantly lower odds of inappropriate testing, whereas those that did not had no effect.” They reported that all studies had potential sources of bias that could have affected the observed estimates.

The authors noted that their findings were similar to those found in previous studies, that interventions using physician audit and feedback are associated with lower odds of inappropriate cardiac testing.

“[T]he study observed a 50 percent reduction in inappropriate tests with a multifaceted educational, audit and feedback intervention, which is consistent with the results of our meta-analysis,” they wrote.

Further research is required, however, with greater diversity of intervention types and improved study designs, the authors concluded.