An initiative to promote value‐based stress test selection in primary care and cardiology clinics: A mixed methods evaluation.
Objectives: Exercise stress echocardiograms (stress echos) are overused, whereas exercise stress electrocardiograms (stress ECGs) can be an appropriate, lower‐cost substitute. In this post hoc, mixed methods evaluation, we assessed an initiative promoting value‐based, guideline‐concordant ordering p...
| Publicado en: | Journal of Evaluation in Clinical Practice Vol. 30; no. 1; pp. 107 - 119 |
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| Autores principales: | , , , , , , , , , , , , |
| Formato: | algorithm pictorial research tables/charts Journal Article |
| Publicado: |
Wiley-Blackwell
Feb2024
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=175750872&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 175750872 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 13561294 EV1 jtl: Journal of Evaluation in Clinical Practice issn: 13561294 maglogo: Y pubinfo: dt: Feb2024 vid: 30 iid: 1 pid: 480 pub: Wiley-Blackwell place: Malden, Massachusetts artinfo: ui: 175750872 164932959 175750872 175750872 10.1111/jep.13896 175750872 ppf: 107 ppct: 12 formats: tig: atl: An initiative to promote value‐based stress test selection in primary care and cardiology clinics: A mixed methods evaluation. aug: au: Kling, Samantha M. R. Kalwani, Neil M. Winget, Marcy Gupta, Kush Saliba‐Gustafsson, Erika A. Baratta, Juliana Garvert, Donn W. Veruttipong, Darlene Brown‐Johnson, Cati G. Vilendrer, Stacie Gaspar, Cindie Levin, Eleanor Tsai, Sandra affil: Evaluation Sciences Unit, Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford California,, USA sug: subj: Exercise Test, Cardiopulmonary Utilization Echocardiography Utilization Health Services Misuse Exercise Test, Cardiopulmonary Methods Exercise Test, Cardiopulmonary Economics Electrocardiography Economics Decision Support Systems, Clinical Implementation Science Value-Based Health Care Practice Patterns Physicians, Family Cardiologists Academic Medical Centers Human Multimethod Studies Funding Source Post Hoc Analysis Electronic Health Records Point-of-Care Testing Interviews Turnaround Time Descriptive Statistics Primary Health Care Quality Improvement Health Care Costs ab: Objectives: Exercise stress echocardiograms (stress echos) are overused, whereas exercise stress electrocardiograms (stress ECGs) can be an appropriate, lower‐cost substitute. In this post hoc, mixed methods evaluation, we assessed an initiative promoting value‐based, guideline‐concordant ordering practices in primary care (PC) and cardiology clinics. Methods: Change in percent of stress ECGs ordered of all exercise stress tests (stress ECGs and echos) was calculated between three periods: baseline (January 2019–February 2020); Period 1 with reduced stress ECG report turnaround time + PC‐targeted education (began June 2020); and Period 2 with the addition of electronic health record‐based alternative alert (AA) providing point‐of‐care clinical decision support. The AA was deployed in two of five PC clinics in July 2020, two additional PC clinics in January 2021, and one of four cardiology clinics in February 2021. Nineteen primary care providers (PCPs) and five cardiologists were interviewed in Period 2. Results: Clinicians reported reducing ECG report turnaround time was crucial for adoption. PCPs specifically reported that value‐based education helped change their practice. In PC, the percent of stress ECGs ordered increased by 38% ± 6% (SE) (p < 0.0001) from baseline to Period 1. Most PCPs identified the AA as the most impactful initiative, yet stress ECG ordering did not change (6% ± 6%; p = 0.34) between Periods 1 and 2. In contrast, cardiologists reportedly relied on their expertise rather than AAs, yet their stress ECGs orders increased from Period 1 to 2 to a larger degree in the cardiology clinic with the AA (12% ± 5%; p = 0.01) than clinics without the AA (6% ± 2%; p = 0.01). The percent of stress ECGs ordered was higher in Period 2 than baseline for both specialties (both p < 0.0001). Conclusions: This initiative influenced ordering behaviour in PC and cardiology clinics. However, clinicians' perceptions of the initiative varied between specialties and did not always align with the observed behaviour change. pubtype: Academic Journal doctype: algorithm pictorial research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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