title: Trends in outpatient transthoracic echocardiography: impact of appropriateness criteria publication.
abstract: BACKGROUND
  The impact of the 2007 American College of Cardiology Foundation Transthoracic Echocardiography Appropriateness Criteria on trends in appropriateness is unknown. Therefore, we sought to identify the appropriateness of outpatient transthoracic echocardiography pre- and postpublication of this document.
  
  
  METHODS
  The 2007 Appropriateness Criteria were used to classify outpatient echocardiographic studies at an academic medical center during October 2000 and October 2008. The patient's electronic medical record was used to identify echocardiographic indication and appropriateness.
  
  
  RESULTS
  From October 2000 to October 2008, there was an 85% increase in outpatient echocardiographic volume. Using the Appropriateness Criteria, there was no significant change in inappropriate referrals (13% and 15%, P=.58). Sixty-five studies (12%) were referred for indications "not addressed" by the document, with an increase (7% to 15%, P=.012) from 2000 to 2008. In a second analysis, incorporating the 2008 Valve Guidelines, an increase was demonstrated in the total number of studies that could be classified, but there was no significant change in the proportion of inappropriate referrals (P=.50). There remained a significant increase (3% to 10%, P=.009) in the proportion of indications "not addressed" by either guideline.
  
  
  CONCLUSIONS
  From October 2000 to October 2008, we experienced a near doubling of outpatient echocardiographic volume, with no significant change in the percent of inappropriate referrals despite interim publication of the Appropriateness Criteria document. In addition, there was an increase in echocardiographic referrals for "not addressed" indications. Future efforts are needed both to refine the Appropriateness Criteria to include unaddressed indications and to promote its effective implementation.
authors.affiliation: Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
authors.forename: Ali R
authors.initials: AR
authors.lastname: Rahimi
authors.forename: Meghan
authors.initials: M
authors.lastname: York
authors.forename: Neil
authors.initials: N
authors.lastname: Gheewala
authors.forename: Larry
authors.initials: L
authors.lastname: Markson
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Hauser
authors.forename: Warren J
authors.initials: WJ
authors.lastname: Manning
mesh_terms: D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000639:trends*; D002309:Cardiology / Q000379:methods / Q000639:trends*; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging; D015986:Confounding Factors, Epidemiologic; D004452:Echocardiography / Q000592:standards* / Q000706:statistics & numerical data* / Q000639:trends; D005260:Female; D058006:General Practice / Q000379:methods / Q000639:trends*; D006801:Humans; D008297:Male; D016347:Medical Records Systems, Computerized; D008875:Middle Aged; D010045:Outpatients / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014600:Utilization Review