title: Utilization patterns of single-photon emission cardiac tomography myocardial perfusion imaging studies in a rural tertiary care setting.
abstract: BACKGROUND
  Appropriate use criteria (AUC) for single-photon emission computed tomographic myocardial perfusion imaging (SPECT MPI) were revised in 2009 to include 15 new clinical scenarios. We assessed multivariable predictors and overall appropriateness of MPI studies performed in a rural tertiary care setting.
  
  
  OBJECTIVE
  We hypothesized that appropriate utilization rates of SPECT MPI imaging in a rural tertiary care center are similar for cardiology and non cardiology providers.
  
  
  METHODS
  We reviewed all SPECT MPI studies performed for over a 6-month period at our center. Using 67 scenarios in AUC, we categorized these studies as appropriate, inappropriate, uncertain, or unclassifiable.
  
  
  RESULTS
  Of 328 MPI studies, 287 (88%) studies were classified as appropriate, 18 (5.5%) as inappropriate, 23 (7%) as uncertain, and none as unclassifiable. Preoperative testing accounted for 44% of the inappropriate studies; 61% of uncertain tests were ordered for cardiovascular risk assessment in patients with prior normal coronary angiography or normal stress tests. The ordering provider specialty did not show any relation with appropriateness of the test (P = 0.46). Patients with inappropriate and uncertain studies were younger than patients with appropriate studies (P = 0.007).
  
  
  CONCLUSIONS
  We found that a majority of MPI studies are performed for appropriate indications regardless of ordering provider specialty. Few common scenarios accounted for the majority of the inappropriate or uncertain studies.
authors.affiliation: Section of Cardiology, Guthrie Clinic/Robert Packer Hospital, Sayre, Pennsylvania.
authors.forename: Maninder
authors.initials: M
authors.lastname: Singh
authors.forename: Zaruhi
authors.initials: Z
authors.lastname: Babayan
authors.forename: Kishore J
authors.initials: KJ
authors.lastname: Harjai
authors.forename: Paras
authors.initials: P
authors.lastname: Dedhia
authors.forename: Sudhakar
authors.initials: S
authors.lastname: Sattur
authors.forename: Dinesh H
authors.initials: DH
authors.lastname: Jagasia
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging*; D005260:Female; D019983:Guideline Adherence / Q000639:trends; D006300:Health Services Misuse / Q000639:trends; D006801:Humans; D008297:Male; D008511:Medicine / Q000639:trends; D008875:Middle Aged; D015999:Multivariate Analysis; D055414:Myocardial Perfusion Imaging / Q000706:statistics & numerical data / Q000639:trends*; D010043:Outcome and Process Assessment, Health Care / Q000639:trends*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000639:trends*; D011237:Predictive Value of Tests; D019035:Rural Health Services / Q000706:statistics & numerical data / Q000639:trends*; D062606:Tertiary Care Centers / Q000706:statistics & numerical data / Q000639:trends*; D015899:Tomography, Emission-Computed, Single-Photon / Q000706:statistics & numerical data / Q000639:trends*; D014481:United States