CDS tool cuts inappropriate heart imaging tests

Using an appropriate use criteria decision support tool can eliminate inappropriate imaging examinations to evaluate coronary artery disease, according to a study published recently in the Journal of the American College of Cardiology.

Researchers performed an eight-month prospective multicenter cohort study in which they created an online questionnaire to help physicians decide the appropriateness of an imaging test. After physicians entered the details onto the questionnaire, the decision support tool assessed the appropriateness of the test based on the American College of Cardiology Appropriate Use Criteria for myocardial perfusion scintigraphy, stress echocardiography, and coronary CT angiography.

Patients involved in the study were insured by United HealthCare, which exempted participating physicians from radiology benefits managers preauthorization requirements; this gave the physicians the latitude to decide which diagnostic tests to give their patients, regardless of the system's determination of appropriateness.

For the study, 100 physicians used the decision-aid for 472 heart patients. The researchers focused on three common cardiac imaging tests: MRI, stress echocardiography and CT angiogram.

Over the eight-month period, the researchers determined that inappropriate tests decreased from 22 percent to 6 percent, while studies deemed appropriate by ACC criteria increased from 49 percent to 61 percent.

"The possibility here is that this immediate feedback through the physician-support tool, at a time when a different test can be ordered, can serve as a very useful adjunct or replace prior authorization procedures in a manner that is physician-preferred rather than policy-based," senior author James Min, M.D., of Cedars-Sinai Heart Institute, told

Christ Sistrom, M.D., a radiologist and health economist with Partner's HealthCare at the University of Florida, told Reuters that the study, "reinforces and replicates what others have shown in the same area of clinical decision support for imaging: it can be done and it works." According to Reuters, Sistrom, who was not involved in this study, reported similar results when researching a doctor feedback system at Massachusetts General Hospital, with the number of inappropriate CT scans being cut from 20 percent to 10 percent within one month.

To learn more:
- see the study in the Journal of the American College of Cardiology
- take a look at the article on
read the article from Reuters Health

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