title: Clinician-dependent variations in inappropriate use of myocardial perfusion imaging: training, specialty, and location.
abstract: BACKGROUND
  Inappropriate use of myocardial perfusion imaging (MPI) may vary depending on the training, specialty, or practice location of the clinician.
  
  
  METHODS
  We conducted a cross-sectional investigation of consecutive patients who underwent MPI at our Veterans Affairs medical center between December 2010 and July 2011. Characteristics of the MPI ordering clinicians were extracted to investigate any associations with inappropriate use.
  
  
  RESULTS
  582 patients were included, 9.8% were inappropriate. No difference in inappropriate use was observed between cardiology and non-cardiology clinicians (n = 21, 9.5% vs n = 36, 10.0%, P = .83); no difference was noted between nurse practitioners/physician assistants, attending physicians, and housestaff (7.5% vs 11.2% vs 1.8%, P = .06). Comparing inpatient, emergency department and outpatient clinician groups, the difference was null (8.6% vs 6.3% vs 10.1%, P = .75). For most clinician groups, the most common inappropriate indication was an asymptomatic scenario; however, some groups were different: definite acute coronary syndrome for inpatient clinicians and low risk syncope for emergency medicine clinicians.
  
  
  CONCLUSIONS
  Clinician groups appear to order inappropriate MPI at similar rates, regardless of their training, specialty, or practice location. Differences in the most common type of inappropriate testing suggest that interventions to reduce inappropriate use should be tailored to specific clinician types.
authors.affiliation: Malcom Randall VA Medical Center, 1601 SW Archer Rd 111D, Gainesville, FL, 32608, USA, david.winchester@va.gov.
authors.forename: David E
authors.initials: DE
authors.lastname: Winchester
authors.forename: Joseph
authors.initials: J
authors.lastname: Hymas
authors.forename: Ryan
authors.initials: R
authors.lastname: Meral
authors.forename: Daniel
authors.initials: D
authors.lastname: Nguyen
authors.forename: Raman
authors.initials: R
authors.lastname: Dusaj
authors.forename: Leslee J
authors.initials: LJ
authors.lastname: Shaw
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Beyth
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002983:Clinical Competence / Q000706:statistics & numerical data*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D005260:Female; D005431:Florida / Q000453:epidemiology; D006748:Hospital Departments / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008503:Medical Staff / Q000706:statistics & numerical data*; D008511:Medicine / Q000706:statistics & numerical data; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000706:statistics & numerical data*; D015588:Observer Variation; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D015995:Prevalence; D019564:Unnecessary Procedures / Q000706:statistics & numerical data*; D014600:Utilization Review; D058014:Veterans Health / Q000706:statistics & numerical data