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18.11.2019 | Original Article

Appropriateness of inpatient stress testing: Implications for development of clinical decision support mechanisms and future criteria

Zeitschrift:
Journal of Nuclear Cardiology
Autoren:
MD Sanjay Divakaran, MBBS Avinainder Singh, MD Ersilia M. DeFilippis, MD Timothy W. Churchill, MD Sarah Cuddy, MD Yin Ge, MD, MPH Ivan K. Ip, MD, MPH Wunan Zhou, MD, MSc Hicham Skali, MD, MPH Viviany R. Taqueti, MD, MPH Sharmila Dorbala, PharmD, MS, MBA James Spalding, MD, PhD Yanqing Xu, MD, MPH Ramin Khorasani, MD Marcelo F. Di Carli, MD Maria A. Yialamas, MD Ron Blankstein, for the Brigham and Women’s Hospital Internal Medicine Residency
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s12350-019-01955-x) contains supplementary material, which is available to authorized users.
The authors of this article have provided a PowerPoint file, available for download at SpringerLink, which summarises the contents of the paper and is free for re-use at meetings and presentations. Search for the article DOI on SpringerLink.com.
Funding This work was funded by the Housestaff Research Grant from the Department of Medicine, Brigham and Women’s Hospital awarded to Dr. Divakaran and Dr. Blankstein and in part by a research grant from Astellas Pharma Global Development, Inc.. Dr. Divakaran and Dr. Zhou are supported by Grant Number T32 HL094301 from the National Heart, Lung, and Blood Institute. Dr. Taqueti is supported by Grant Number K23 HL135438 from the National Heart, Lung, and Blood Institute. Dr. Dorbala is supported by Grant Number R01 HL130563 from the National Heart, Lung, and Blood Institute. Dr. Di Carli is supported by Grant Number R01 HL132021 from the National Heart, Lung, and Blood Institute.

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Abstract

Background

An upcoming national mandate will require consultation of appropriate use criteria (AUC) through a clinical decision support mechanism (CDSM) for advanced imaging. We aimed to evaluate our current ability to ascertain test appropriateness.

Methods

We prospectively collected data on 288 consecutive stress tests and coronary computed tomography angiography studies for medical inpatients. Study appropriateness was determined independently by two physicians using the 2013 Multimodality AUC.

Results

The median age of the study population was 66 years [interquartile range (IQR) 56, 75], 40.8% were female, and 52.8% had a history of coronary artery disease. Review of the electronic health record (EHR) alone was sufficient to deem appropriateness for 87.2% of cases. The most common reason it was insufficient was inability to determine if the patient could exercise (59.5%). After reviewing the EHR and pilot CDSM data together, appropriateness could be determined for 95.8% of the cases. The most common reason appropriateness could not be determined was that the exam indication was not addressed by an AUC criterion (83.3%).

Conclusion

In preparing for the mandate, it will be important for future CDSM to obtain information on the patient’s ability to exercise and for future AUC to include additional indications that are not currently addressed.

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