title: The impact of individual variation analysis on myocardial perfusion imaging utilization within a hospitalist group.
abstract: BACKGROUND
  Increased recognition of ionizing radiation risks has placed an emphasis on the appropriate use of myocardial perfusion imaging (MPI). Hospitalists frequently order MPI in the evaluation of chest pain and are thus at the forefront of its inpatient utilization.
  
  
  METHODS
  We collected baseline figures for a group MPI rate (March 2010-February 2011) as well as individual MPI rates for hospitalists caring for cardiac floor patients at a community teaching hospital. We performed a 2-part intervention; we presented the individual MPI rate data back to the hospitalist division and carried out longitudinal educational efforts on MPI appropriateness criteria. We then calculated the group MPI utilization rate for 3 postintervention periods (March 2011-February 2012, March 2012-February 2013, and March 2013-February 2014) and the MPI rate for the subgroup of cardiac floor patients. Finally, we calculated the percentage of inappropriately performed stress tests before and after our intervention.
  
  
  RESULTS
  Group MPI rate declined from 6.1% to 5.0% in the first year after our intervention (P = 0.009); a decrease was maintained a year later-MPI rate 4.9% (P = 0.004)-and became even more pronounced 2 years later-MPI rate 3.9% (P < 0.0001). The MPI rate for the subgroup of patients on the cardiac floor similarly decreased from 8.0% to 6.7% (P = 0.039). Finally, we report a particularly encouraging and significant trend of a 46% postintervention decrease (from 16.5% to 9%, P = 0.034) in the proportion of inappropriate stress tests ordered.
  
  
  CONCLUSIONS
  Analyzing individual ordering rates and combining them with educational efforts was an effective strategy for impacting MPI utilization in the hospitalist group studied.
authors.affiliation: Division of Hospital Medicine, Newton-Wellesley Hospital, Newton, Massachusetts.
authors.forename: Hacho B
authors.initials: HB
authors.lastname: Bohossian
authors.forename: Allison W
authors.initials: AW
authors.lastname: Park
authors.forename: Christina
authors.initials: C
authors.lastname: Holcroft
mesh_terms: D020445:Hospitalists / Q000592:standards*; D006801:Humans; D055414:Myocardial Perfusion Imaging / Q000592:standards* / Q000706:statistics & numerical data*; D015588:Observer Variation; D011446:Prospective Studies; D017062:Small-Area Analysis