Physician variation in ordering of transthoracic echocardiography in outpatient pediatric cardiac clinics

Autor:	Sean M. Lang, Leo Lopez, Christopher Statile, Ritu Sachdeva, George R. Verghese, Scott Gillespie, Nadine F. Choueiter, Courtney McCracken, Kenan W.D. Stern
Rok vydání:	2020
Předmět:	medicine.medical_specialty Patient characteristics 030204 cardiovascular system & hematology Chest pain Subspecialty Appropriate Use Criteria 03 medical and health sciences 0302 clinical medicine Physicians Outpatients medicine Humans Radiology Nuclear Medicine and imaging 030212 general & internal medicine Practice Patterns Physicians' Child Retrospective Studies business.industry Variance (accounting) Explained variation body regions Outpatient visits Echocardiography Emergency medicine Guideline Adherence medicine.symptom Cardiology and Cardiovascular Medicine business Pediatric cardiology
Zdroj:	Echocardiography. 37:1056-1064
ISSN:	1540-8175 0742-2822
DOI:	10.1111/echo.14756
Popis:	Background The pediatric Appropriate Use Criteria (AUC) for outpatient transthoracic echocardiography (TTE) aim to reduce practice variation. Little is known on variation in TTE use between physicians. Understanding this variation will help identify areas for improvement in standardization of TTE use. Methods and results This is a retrospective review of initial outpatient visits at 6 pediatric cardiology centers in the United States prior to AUC release. Variation in TTE use was examined using multilevel generalized mixed effects models. Forward selection identified combinations of variables that explained the most variance in TTE use between physicians. Due to collinearity, physician compensation model and center were analyzed separately. Of 2883 encounters, the most common indication was murmur (36%), followed by chest pain (15.2%). Overall TTE use was 41.9%, and varied widely between centers (22.9%-52.6%), and between physicians within centers. Center alone explained 29% of this physician variance. Adding physician characteristics increased the variance explained to 57%, which only minimally improved by adding patient characteristics. The variance explained was driven by subspecialty. The center-based multivariable model explained more variance over compensation model. Conclusions Center was the single largest determinant of physician variance in TTE use, followed by physician subspecialty. Efforts to reduce practice variation, such as the AUC, should be employed across centers and all pediatric cardiac providers. Center appears to have a stronger impact on variance than compensation model, though in this dataset the effect of center and compensation are hard to separate from each other and deserve further evaluation.
Databáze:	OpenAIRE
Externí odkaz:	https://explore.openaire.eu/search/publication?articleId=doi_dedup___::2389aa1ce9ab78fcf94206a751928445 https://doi.org/10.1111/echo.14756 Zobrazit plný text záznamu Plný text ve formátu PDF Plný text ve formátu HTML
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