par Brendon Nafziger
, DOTmed News Associate Editor | August 10, 2012
A quality control program can help cut down the rate of unnecessary heart CT scans, according to a new study.
Researchers writing in a paper published online Wednesday in the Journal of the American College of Cardiology found that a program of data-monitoring, educational activities, performance feedback and warnings over possible lack of coverage for overuse helped reduce the rate of inappropriate heart CT scans from 15 percent to 6 percent of scans.
"This study demonstrates that a [continuous quality improvement initiative] incorporating education and systematic peer-group feedback in a 'real-world' setting across a variety of institutions and physician specialties is associated with more appropriate [coronary computed tomography angiography] use," wrote the researchers, led by Dr. Kavitha M. Chinnaiyan with William Beaumont Hospital in Royal Oak, Mich.
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Half a million Americans undergo CCTA scans every year, the researchers said, making it the fastest growing CT application in the United States. While the technology is accurate at quickly detecting blocked arteries, especially in moderate-risk patients, the rapid growth of the modality has led to worries about overuse, as an average scan costs between $500 and $1,500, the researchers said.
The statewide study, sponsored by Blue Cross Blue Shield/Blue Care Network of Michigan, included 47 centers that perform CCTA and that are part of BCBS' Advanced Cardiovascular Imaging Consortium, a quality improvement program.
For the study, the researchers classified CCTA scans in three categories: appropriate, generally for medium-risk patients with symptoms; inappropriate, such as scans ordered for low-risk patients without symptoms; and uncertain, where the utility of the scan was unclear. Scans that differently fit these groups were dubbed "unclassifiable."
The researchers then measured the number of scans in each category in the pre-intervention period in July 2007 to June 2008; the intervention period, when the quality improvement program was introduced, from July 2008 through June 2010; and then the follow-up period, from July through December 2010.
According to the researchers, the number of scans classified as inappropriate fell from about 15 percent of scans in the pre-intervention period (873 out of 5,993) to nearly 6 percent of scans in the follow-up period (192 out of 3,302). Similarly, uncertain scans also declined from 10 percent (618 out of 5,993) to about 6 percent (202 out of 3,302), and unclassifiable scans dropped from 14 percent (830 out of 5,993) to 8 percent (266 out of 3,302).
Meanwhile, scans deemed appropriate rose from 61 percent in the pre-intervention period (3,672 out of 5,993) to 80 percent in the follow-up period (2,642 out of 3,302), the researchers said.
The study is "Impact of a Continuous Quality Improvement Initiative on Appropriate Use of Coronary Computed Tomography Angiography."