A study of the use of transthoracic echocardiography (TTE) at an academic medical center suggests that although 9 in 10 of the procedures were appropriate under 2011 appropriate use criteria, less than 1 in 3 of the TTEs resulted in an active change in care, according to a report of the research by Susan Matulevicius, M.D., and colleagues at the University of Texas Southwestern Medical Center, Dallas.
The researchers, who studied 535 patients undergoing TTE, found that, overall, 31.8 percent of TTEs resulted in an active change in care; 46.9 percent resulted in a continuation of current care; and 21.3 percent prompted no change in care, according to the results.
"The low rate of active change in care (31.8 percent) among TTEs mostly classified as appropriate (91.8 percent) highlights the need for a better method to optimize TTE utilization to use limited health care resources efficiently while providing high-quality care," the study concludes.
(JAMA Intern Med. Published online July 22, 2013. doi:10.1001/jamainternmed.2013.8972. Available pre-embargo to the media at http://media.jamanetwork.com.)
Editor's Note: This study was supported in part by a grant from the University of Texas Science and Technology Acquisition and Retention program and by the National Center for Advancing Translational Sciences and the National Institutes of Health. Please see article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
Commentary: Appropriate vs. Clinically Useful Diagnostic Tests
In a related commentary, John P.A. Ioannidis, M.D., D.Sc., of Stanford University, California, writes: "Transthoracic echocardiography is the most popular cardiac imaging study; approximately 700 TTE studies are performed annually per 1,000 Medicare beneficiaries. Given its popularity, cost can easily escalate unless some restriction is set on which TTEs are deemed appropriate to perform."
"The study by Matulevicius et al demonstrates that the concepts of appropriateness and usefulness may diverge considerably. Transthoracic echocardiograms cost more than $1 billion per year to Medicare alone, and many TTE procedures performed by the book may still not lead to improved outcomes," he writes.
(JAMA Intern Med. Published online July 22, 2013. doi:10.1001/jamainternmed.2013.6582. Available pre-embargo to the media at http://media.jamanetwork.com.)
Editor's Note: Please see article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
Journal
JAMA Internal Medicine