title: Impact of a continuous quality improvement initiative on appropriate use of coronary computed tomography angiography. Results from a multicenter, statewide registry, the Advanced Cardiovascular Imaging Consortium.
abstract: OBJECTIVE
  The purpose of the study was to determine the effectiveness of a collaborative educational, continuous quality improvement (CQI) initiative to increase appropriate use of coronary computed tomography angiography (CCTA).
  
  
  BACKGROUND
  Potential overuse of CCTA has prompted multisociety appropriate use criteria (AUC) publications.
  
  
  METHODS
  This prospective, observational study was conducted with pre-intervention (July 2007 to June 2008), intervention (July 2008 to June 2010), and follow-up (July 2010 to December 2010) periods during which patients were enrolled in the Advanced Cardiovascular Imaging Consortium (ACIC) at 47 Michigan hospitals. Continuous education was provided to referring physicians. The possibility of losing third-party payer coverage in the absence of a measurable change in AUC was emphasized. AUC was compared between the 3 periods.
  
  
  RESULTS
  The study group included 25,387 patients. Compared with the pre-intervention period, there was a 23.4% increase in appropriate (61.3% to 80%, p < 0.0001), 60.3% decrease in inappropriate (14.6% to 5.8%, p < 0.0001), 40.8% decrease in uncertain (10.3% to 6.1%, p < 0.0001), and 41.7% decrease in unclassifiable (13.9% to 8.1%, p < 0.0001) scans during follow-up. Between pre-intervention and follow-up, change in CCTA referrals by provider specialty were cardiology (appropriate: 60.4% to 79.5%; inappropriate: 13% to 5.2%; p < 0.0001), internal medicine/family practice (appropriate: 51.1% to 70.4%; inappropriate: 20.2% to 12.5%; p < 0.0001), emergency medicine (appropriate: 83.6% to 91.6%; inappropriate: 9.1% to 0.6%; p < 0.0001), and other (appropriate: 61.1% to 83.2%; inappropriate: 18.6% to 5.9%; p < 0.0001).
  
  
  CONCLUSIONS
  Application of a systematic CQI and emphasis on possible loss of coverage were associated with a significant improvement in the proportion of CCTA examinations meeting AUC across referring physician specialties.
authors.affiliation: William Beaumont Hospital, 3601 West 13 Mile Road, Royal Oak, Michigan 48073, USA. kchinnaiyan@beaumont.edu
authors.forename: Kavitha M
authors.initials: KM
authors.lastname: Chinnaiyan
authors.forename: Patricia
authors.initials: P
authors.lastname: Peyser
authors.forename: Tauqir
authors.initials: T
authors.lastname: Goraya
authors.forename: Karthikeyan
authors.initials: K
authors.lastname: Ananthasubramaniam
authors.forename: Michael
authors.initials: M
authors.lastname: Gallagher
authors.forename: Ann
authors.initials: A
authors.lastname: Depetris
authors.forename: Judith A
authors.initials: JA
authors.lastname: Boura
authors.forename: Ella
authors.initials: E
authors.lastname: Kazerooni
authors.forename: Chad
authors.initials: C
authors.lastname: Poopat
authors.forename: Mouaz
authors.initials: M
authors.lastname: Al-Mallah
authors.forename: Souheil
authors.initials: S
authors.lastname: Saba
authors.forename: Smita
authors.initials: S
authors.lastname: Patel
authors.forename: Steven
authors.initials: S
authors.lastname: Girard
authors.forename: Thomas
authors.initials: T
authors.lastname: Song
authors.forename: David
authors.initials: D
authors.lastname: Share
authors.forename: Gilbert
authors.initials: G
authors.lastname: Raff
mesh_terms: D000328:Adult; D000368:Aged; D017023:Coronary Angiography / Q000592:standards / Q000706:statistics & numerical data*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D004502:Education, Medical, Continuing; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015397:Program Evaluation; D011446:Prospective Studies; D058996:Quality Improvement / Q000592:standards*; D012042:Registries; D016896:Treatment Outcome