title: Gender disparity and the appropriateness of myocardial perfusion imaging.
abstract: BACKGROUND
  Appropriate use criteria (AUC) were developed to guide the use of myocardial perfusion imaging (MPI). While MPI use has grown exponentially, women remain under tested. Given this bias in testing, we sought to determine if gender disparity exists in tests categorized by appropriateness and the role of referral bias.
  
  
  METHODS
  The AUC were applied to 314 consecutive MPI. Analysis of variance and chi-squared tests were used for analysis. Gender disparity was assessed using correlation matrices comparing baseline to gender reversed data.
  
  
  RESULTS
  Of the 314 studies, 263 were appropriate, 34 inappropriate, and 17 uncertain. Women had 68% of inappropriate studies, and 82% of uncertain studies (P < .01). Cardiologists ordered more appropriate studies than primary care physicians (PCPs) in women (86% vs 71%, P = .04). Among studies ordered by cardiologists and PCPs, a higher percentage of studies were appropriate in men vs women (96% vs 86%, P = 0.05 and 88% vs 71% P = .003), respectively. Gender reversal demonstrates disparity in the AUC tool with 46 (15%) not correlating (P < .00001).
  
  
  CONCLUSIONS
  Comparing patient gender and ordering physician, the majority of inappropriate and uncertain studies were ordered in women by PCPs, indicating a continuing need for education among PCPs, particularly as the AUC apply to women.
authors.affiliation: Department of Medicine, Miriam and Rhode Island Hospital, Main Building Room 209, 593 Eddy St., Providence, RI 02903, USA. agupta@lifespan.org
authors.forename: Aarti
authors.initials: A
authors.lastname: Gupta
authors.forename: Sarah V
authors.initials: SV
authors.lastname: Tsiaras
authors.forename: Shira I
authors.initials: SI
authors.lastname: Dunsiger
authors.forename: Peter L
authors.initials: PL
authors.lastname: Tilkemeier
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging; D058007:Physicians, Primary Care; D012017:Referral and Consultation; D012737:Sex Factors; D015899:Tomography, Emission-Computed, Single-Photon