title: The impact of ordering provider specialty on appropriateness classification.
abstract: BACKGROUND
  There is limited published data comparing the appropriateness use criteria for SPECT MPI with the specialty of the ordering provider. The aim of this study was to examine if the specialty of the ordering provider affected either the ordering indication or the appropriateness of stress SPECT MPI.
  
  
  RESULTS
  The ordering provider’s specialty was compared with the study indication and appropriateness rating. There were modest but significant differences in general indications by specialty. For example, the Emergency Department group ordered fewer studies in asymptomatic patients (3% compared to 14%-23% in the other four referral groups). In contrast, 43% of the studies ordered by Cardiovascular Division physicians and 39% of the studies ordered by the Registered Nurse group were on post-revascularization patients, compared to 23%-31% of those ordered by the other three groups. Overall appropriateness classification did not differ among the five specialty groups (P 5 0.19).
  
  
  CONCLUSIONS
  In a clinical practice where pre-operative testing using SPECT is infrequent,the rate of inappropriate studies was similar for all ordering providers. Quality improvement efforts in similar practices will likely require a broad educational focus on all ordering providers.
authors.affiliation: Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN, USA. carryer.damita@mayo.edu
authors.forename: Damita Jo
authors.initials: DJ
authors.lastname: Carryer
authors.forename: J Wells
authors.initials: JW
authors.lastname: Askew
authors.forename: David
authors.initials: D
authors.lastname: Hodge
authors.forename: Todd D
authors.initials: TD
authors.lastname: Miller
authors.forename: Raymond J
authors.initials: RJ
authors.lastname: Gibbons
mesh_terms: D000368:Aged; D005260:Female; D006300:Health Services Misuse / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008511:Medicine / Q000706:statistics & numerical data*; D008910:Minnesota / Q000453:epidemiology; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D014600:Utilization Review