Educational Intervention to Reduce Outpatient Inappropriate Transthoracic Echocardiograms

NCT01944202 | Completed DMC

• 1 other identifier: 2011P001779CR1
• Study Type: interventional
• Target: 112
• Locations: 1 country
• Sites: 1

Brief Summary

It is well documented that the proportion of inappropriate transthoracic echocardiograms (TTEs) is highest in the ambulatory environment, where it has been reported as high as 30%. Therefore, the potential to improve TTE utilization may be greatest in the outpatient setting. However, no study to date has evaluated whether an Appropriate Use Criteria (AUC)-based educational intervention can reduce inappropriate TTEs in this setting. The investigators therefore designed the first randomized control trial of an AUC-based educational and feedback intervention aimed at reducing inappropriate outpatient TTEs ordered by cardiology and internal medicine physicians in training.

Conditions

Inappropriate Use of Echocardiography

Keywords

Echocardiography; Appropriate Use Criteria; Educational Intervention

Outcome Measures

Primary Outcomes (1)

• Rate of Inappropriate transthoracic echocardiograms

  Rate of inappropriate echocardiograms determined from a review of the electronic medical record.

  9 months

Secondary Outcomes (1)

• Rate of Appropriate Transthoracic Echocardiograms

  9 months

Other Outcomes (1)

• Clinical reasons for appropriate and inappropriate transthoracic echocardiograms

  9 months

Study Arms (2)

Educational Intervention

EXPERIMENTAL

Physicians in the intervention arm receive the following multi-faceted educational intervention on transthoracic echocardiogram appropriateness: 1) a lecture at the beginning of the study period, which describes the Appropriate Use Criteria (AUC) for echocardiography and highlights common clinical scenarios for which outpatient TTEs are ordered, 2) an electronic "pocket card" via email that provides tips on appropriate ordering of TTEs, and 3) an individualized monthly feedback report that categorized TTEs ordered over the preceding month. The feedback reports contains the number of TTEs ordered during the month and how many are classified as appropriate, inappropriate, or uncertain based on the 2011 AUC.

Behavioral: Educational intervention

Control group

NO INTERVENTION

Physicians in the control arm have their TTE orders tracked and classified, but do not receive any feedback on their ordering behavior.

Interventions

Educational intervention BEHAVIORAL

Educational and feedback intervention, as described in the Arm Description.

Educational Intervention

Eligibility Criteria

• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

• Cardiovascular Medicine fellows at Massachusetts General Hospital
• Internal Medicine residents at Massachusetts General Hospital

You may not qualify if:

• Attending physicians

Sponsors & Collaborators

• Massachusetts General Hospital: lead

Study Sites (1)

Massachusetts General Hospital

Boston, Massachusetts, 02114, United States

Location

Related Publications (1)

• Bhatia RS, Dudzinski DM, Malhotra R, Milford CE, Yoerger Sanborn DM, Picard MH, Weiner RB. Educational intervention to reduce outpatient inappropriate echocardiograms: a randomized control trial. JACC Cardiovasc Imaging. 2014 Sep;7(9):857-66. doi: 10.1016/j.jcmg.2014.04.014. Epub 2014 Aug 13.

  PMID: 25129520 DERIVED

MeSH Terms

Interventions

Early Intervention, Educational

Intervention Hierarchy (Ancestors)

Child Health Services; Community Health Services; Health Services; Health Care Facilities Workforce and Services; Preventive Health Services

Study Officials

• Rory B Weiner, MD

  Massachusetts General Hospital

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: INVESTIGATOR
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Assistant Professor Medicine

Study Record Dates

• First Submitted: September 10, 2013
• First Posted: September 17, 2013
• Study Start: August 1, 2012
• Primary Completion: April 1, 2013
• Study Completion: May 1, 2013
• Last Updated: September 17, 2013

Record last verified: 2013-09

Locations

US (1)