Application of Appropriateness Criteria to Stress Single-Photon Emission Computed Tomography Sestamibi Studies and Stress Echocardiograms in an Academic Medical Center
Raymond J. Gibbons, MD, FACC*,*,
Todd D. Miller, MD, FACC*,
David Hodge, MSc ,
Lynn Urban,
Philip A. Araoz, MD ,
Patricia Pellikka, MD, FACC* and
Robert B. McCully, MD, FACC*
* Division of Cardiovascular Diseases, Department of Medicine, Mayo Foundation, Mayo Clinic, Rochester, Minnesota
Department of Biostatistics, Mayo Foundation, Mayo Clinic, Rochester, Minnesota
Department of Radiology, Mayo Foundation, Mayo Clinic, Rochester, Minnesota.
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Figure 1 Appropriateness: Table Designation
Indications for testing of 284 stress single-photon emission computed tomography (SPECT) myocardial perfusion imaging and 298 stress echocardiograms (echos) according to the American College of Cardiology Foundation/American Society of Nuclear Cardiology appropriateness criteria for SPECT myocardial perfusion imaging. These were significant differences between SPECT myocardial perfusion imaging and stress echo. MI = myocardial infarction; Preop = pre-operative.
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Figure 2 Appropriateness: Results
Overall classification of the stress SPECT and stress echo studies according to the American College of Cardiology Foundation/American Society of Nuclear Cardiology appropriateness criteria for stress SPECT myocardial perfusion imaging. Abbreviations as in Figure 1.
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Figure 3 Flow Diagram Showing the Potential Identification of Most of the Inappropriate Studies at the "Point of Ordering" With Collection of a Limited Number of Data Elements
For example, if any one of the 3 indications in the first line was present, collection would stop. In contrast, if the study was for pre-operative evaluation, collection would then identify the inappropriate studies shown in the left-hand boxes. ACS = acute coronary syndromes; CHD = coronary heart disease; ECG = electrocardiogram; MI = myocardial infarction.
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