Utilization of radionuclide myocardial perfusion imaging in two health care systems: Assessment with the 2009 ACCF/ASNC/AHA appropriateness use criteria
Utilization of radionuclide myocardial perfusion imaging in two health care systems: Assessment with the 2009 ACCF/ASNC/AHA appropriateness use criteria
复制标题
DOI：
10.1007/s12350-011-9467-8
复制
发表时间：
2012-02-01
影响因子：
2.4
通讯作者：
Hendel, Robert C.
中科院分区：
文献类型：
--
作者：
Nelson, Katarina H.;Willens, Howard J.;Hendel, Robert C.
虽然退伍军人事务部（VA）医院和其他医疗保健系统之间的有创心脏手术的使用率存在差异，但无创心脏成像的使用模式尚未得到很好的研究。我们评估了更新后的适当性使用标准（AUC）确定心肌灌注成像（MPI）利用模式的能力，并比较了学术实践和VA之间的使用。使用2009年AUC中发表的分层方法，对学术实践中的150项负荷/静息MPI研究和VA医院的150项研究进行了回顾性分析。不到1%的研究未分类。在VA，由于不适当的原因要求进行MPI的百分比更高，尽管该差异无统计学显著性（P = .248）。在VA中，非医生比医生要求更多的不适当的研究（26.8%比20.1%; P <0.048）。在学术实践中，非心脏病专家比心脏病专家推荐更多的患者接受不适当的适应症（23.9% vs 10.1%; P = 0.001）。五种最常见的不适当适应症占不适当要求的MPI的绝大多数（77%）。修订后的2009年AUC允许对测试中的适当性进行近乎完整的分类。注意到了机构和提供者类型之间的差异，并确定了改进利用的领域。
Although differences in the rate of utilization of invasive cardiac procedures between Veterans Affairs (VA) hospitals and other health care systems are present, noninvasive cardiac imaging use pattern has not been well studied. We evaluated the ability of the updated appropriateness use criteria (AUC) to determine utilization patterns of myocardial perfusion imaging (MPI) and compare use between an academic practice and a VA.One-hundred fifty stress/rest MPI studies in an academic practice and 150 at a VA hospital were retrospectively reviewed using the hierarchical approach published in the 2009 AUC.Less than 1% of studies were unclassified. A higher percentage of MPI were requested for inappropriate reason at the VA, although this difference was not statistically significant (P = .248). In the VA, non-physicians requested significantly more inappropriate studies than physicians (26.8% vs 20.1%; P < .048). Within the academic practice non-cardiologists referred more patients for inappropriate indications than cardiologists (23.9% vs 10.1%; P = .001). Five most common inappropriate indications accounted for the vast majority of inappropriately requested MPI (77%).The revised 2009 AUC allow for near complete categorization of appropriateness in testing. Differences between institutions and provider types were noted and areas for improved utilization were identified.