title: Comparison of the clinical application of the American College of Cardiology Foundation/American Society of Echocardiography Appropriateness Criteria for outpatient transthoracic echocardiography in academic and community practice settings.
abstract: BACKGROUND
  We sought to compare the clinical application of the American College of Cardiology Foundation/American Society of Echocardiography Appropriateness Criteria (AC) for outpatient transthoracic echocardiography (TTE) in academic and community practice settings.
  
  
  METHODS
  Indications for TTE ordered in both academic and community practice settings were determined by 2 reviewers and categorized according to the AC for TTE as Appropriate, Inappropriate, or Not Addressed. Patient characteristics, ordering physician specialty, and TTE findings were also recorded.
  
  
  RESULTS
  Overall, 814 academic and 319 community TTEs were analyzed. Interobserver variability for indication determination was high and did not differ between studies ordered at the 2 practice settings. Compared with the academic practice, community practice TTE indications were more likely to be classified in the AC for TTE (88% vs 82%, P = .04), but were ordered for a similar frequency of Appropriate (71% vs 68%, P = not significant) and Inappropriate (17% vs 15%, P = not significant) indications. New important TTE abnormalities were more frequently found in Appropriate studies compared with Inappropriate studies in both academic (35% vs 16%, P < .001) and community practice (29% vs 15%, P = .04) settings.
  
  
  CONCLUSIONS
  The clinical application of the AC for TTE is feasible, and the frequency of Appropriate and Inappropriate outpatient TTEs is similar in academic and community practice settings. However, limitations of the AC for TTE are identified that suggest revisions will be needed to fully encompass and stratify the broad clinical practice of echocardiography.
authors.affiliation: Non-Invasive Imaging Laboratories, Section of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois, USA. pward@medicine.bsd.uchicago.edu
authors.forename: R Parker
authors.initials: RP
authors.lastname: Ward
authors.forename: Daniel
authors.initials: D
authors.lastname: Krauss
authors.forename: Ibrahim N
authors.initials: IN
authors.lastname: Mansour
authors.forename: Nicole
authors.initials: N
authors.lastname: Lemieux
authors.forename: Nitin
authors.initials: N
authors.lastname: Gera
authors.forename: Roberto M
authors.initials: RM
authors.lastname: Lang
mesh_terms: D000046:Academic Medical Centers / Q000592:standards / Q000706:statistics & numerical data*; D000553:Ambulatory Care / Q000592:standards* / Q000706:statistics & numerical data*; D002641:Chicago; D003151:Community Health Centers / Q000592:standards / Q000706:statistics & numerical data*; D004452:Echocardiography / Q000592:standards* / Q000706:statistics & numerical data*; D019983:Guideline Adherence / Q000706:statistics & numerical data*