کد مقاله | کد نشریه | سال انتشار | مقاله انگلیسی | نسخه تمام متن |
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5719594 | 1607414 | 2017 | 6 صفحه PDF | دانلود رایگان |
ObjectiveTo assess the appropriateness and diagnostic yield of TTEs ordered by various pediatric providers according to the pediatric appropriate use criteria (AUC) for outpatient transthoracic echocardiography (TTE) before its release.Study designClinic notes of patients aged â¤18 years who underwent initial outpatient TTE between April and September 2014 were reviewed to determine the AUC indication, and appropriateness was assigned based on the AUC document. Ordering physicians were categorized into cardiologists, primary care physicians (PCPs; including pediatricians and family practitioners [FPs]), and noncardiology subspecialists.ResultsOf the 1921 TTEs ordered during the study period, 84.6% were by cardiologists, 9.2% by pediatricians, 3.4% by FPs, and 2.8% by noncardiology subspecialists. The appropriateness rate for cardiologists was higher than that for PCPs (86% vs 64%; Pâ<â.001) but not noncardiology subspecialist (86% vs 87%; Pâ=â.80). PCPs had a significantly higher proportion of studies that could not be classified compared with cardiologists (35% vs 5%; Pâ<â.001) and noncardiology subspecialists (35% vs 11%; Pâ<â.001), owing primarily to a lack of adequate clinical information. The likelihood of an abnormal finding was higher in TTEs ordered by a cardiologist vs those ordered by a noncardiologist (OR, 4.8; 95% CI, 2.1-10.9; Pâ<â.001).ConclusionsCompared with PCPs, cardiologists ordered more TTEs, had the highest yield of abnormal findings, and had greater appropriateness of TTE orders. A large proportion of TTEs ordered by PCPs were unclassifiable owing to insufficient information. This study lays a framework for provider education and improvement in the TTE order intake process.
Journal: The Journal of Pediatrics - Volume 184, May 2017, Pages 137-142