Comparison of echocardiography request appropriateness between public and private hospitals.
BACKGROUND
Aiming at improving the use of echocardiography tests, the Appropriateness Criteria (AC) were created by the American Society of Echocardiography (ASE)/American College of Cardiology (ACC).


OBJECTIVE
To compare the appropriateness profile of transthoracic echocardiography (TTE) requests in accordance with the AC, between a public University Hospital (UH) and a Private Hospital (PH), and verify which characteristics are associated with a better TTE request profile.


METHODS
We prospectively assessed 779 consecutive TTE requests in a PH (49.8%) and a UH (50.2%), with 55.6% of requests for women and 44.4% for men, aged 59.1 ± 15.7 years. The indications were classified as appropriate, inappropriate or non-classified, and adequacy to AC was correlated with age, patient gender, and the time since graduation of the requesting physician. The statistical analysis used Kappa coefficient and chi-square test.


RESULTS
There was no significant difference regarding the adequacy profile of appropriate TTE requests in the two institutions (71% vs. 75%, p = 0.3). At PH, the factors associated with higher rates of appropriate tests were: female gender (p = 0.001) and age younger than 60 years (p <0.001). In the UH, physicians who had graduated between 5 and 10 years before had a higher rate of inappropriate requests (p = 0.02). The variables that were independent predictors of appropriate tests in the PH were: female sex (p = 0.001) and age <60 years (p = 0.001).


CONCLUSIONS
In this evaluation, the PH and the UH profiles showed similar request appropriateness profiles. Female gender, time since graduation of the requesting physician and the patient's age influenced the appropriateness of requests.
Serviço de Ecocardiografia, Hospital Pró-Cardíaco, RJ, Brasil.
Flávia Candolo Pupo
FC
Barbosa
Evandro Tinoco
ET
Mesquita
Laiz Baniziolli
LB
Barachi
Angelo
A
Salgado
Rafael
R
Kazuo
Maria Luiza Garcia
ML
Rosa
Claudio Tinoco
CT
Mesquita
D000367:Age Factors; D001938:Brazil; D004452:Echocardiography / Q000592:standards* / Q000706:statistics & numerical data; D004503:Education, Medical, Graduate / Q000706:statistics & numerical data; D004812:Epidemiologic Methods; D005260:Female; D019983:Guideline Adherence / Q000592:standards* / Q000706:statistics & numerical data; D016304:Hospitals, Private / Q000706:statistics & numerical data; D006779:Hospitals, Public / Q000706:statistics & numerical data; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000592:standards* / Q000706:statistics & numerical data; D012737:Sex Factors; D013997:Time Factors; D019564:Unnecessary Procedures / Q000592:standards* / Q000706:statistics & numerical data