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An initiative to promote value‐based stress test selection in primary care and cardiology clinics: A mixed methods evaluation.
- Source :
- Journal of Evaluation in Clinical Practice; Feb2024, Vol. 30 Issue 1, p107-118, 12p
- Publication Year :
- 2024
-
Abstract
- 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. [ABSTRACT FROM AUTHOR]
- Subjects :
- EXERCISE tests
ECHOCARDIOGRAPHY
STATISTICS
CLINICAL decision support systems
ACADEMIC medical centers
CARDIOPULMONARY system
CARDIOLOGISTS
RESEARCH methodology
POINT-of-care testing
INTERVIEWING
MEDICAL care costs
MEDICAL care use
VALUE-based healthcare
PRIMARY health care
ELECTROCARDIOGRAPHY
RESEARCH funding
TURNAROUND time
DESCRIPTIVE statistics
QUALITY assurance
PHYSICIAN practice patterns
DATA analysis
ELECTRONIC health records
Subjects
Details
- Language :
- English
- ISSN :
- 13561294
- Volume :
- 30
- Issue :
- 1
- Database :
- Complementary Index
- Journal :
- Journal of Evaluation in Clinical Practice
- Publication Type :
- Academic Journal
- Accession number :
- 175750872
- Full Text :
- https://doi.org/10.1111/jep.13896