title: Metrics of quality care in veterans: correlation between primary-care performance measures and inappropriate myocardial perfusion imaging.
abstract: BACKGROUND
  Approximately 10% to 20% of myocardial perfusion imaging (MPI) tests are inappropriate based on professional-society recommendations. The correlation between inappropriate MPI and quality care metrics is not known.
  
  
  OBJECTIVE
  Inappropriate MPI will be associated with low achievement of quality care metrics.
  
  
  METHODS
  We conducted a retrospective cross-sectional investigation at a single Veterans Affairs medical center. Myocardial perfusion imaging tests ordered by primary-care clinicians between December 2010 and July 2011 were assessed for appropriateness (by 2009 criteria). Using documentation of the clinical encounter where MPI was ordered, we determined how often quality care metrics were achieved.
  
  
  RESULTS
  Among 516 MPI patients, 52 (10.1%) were inappropriate and 464 (89.9%) were not inappropriate (either appropriate or uncertain). Hypertension (82.2%), diabetes mellitus (41.3%), and coronary artery disease (41.1%) were common. Glycated hemoglobin levels were lower in the inappropriate MPI cohort (6.6% vs 7.5%; P = 0.04). No difference was observed in the proportion with goal hemoglobin (62.5% vs 46.3% for appropriate/uncertain; P = 0.258). Systolic blood pressure was not different (132 mm Hg vs 135 mm Hg; P = 0.34). Achievement of several other categorical quality metrics was low in both cohorts and no differences were observed. More than 90% of clinicians documented a plan to achieve most metrics.
  
  
  CONCLUSIONS
  Inappropriate MPI is not associated with performance on metrics of quality care. If an association exists, it may be between inappropriate MPI and overly aggressive care. Most clinicians document a plan of care to address failure of quality metrics, suggesting awareness of the problem.
authors: Division of Cardiovascular Medicine, University of Florida College of Medicine.
authors: David E
authors: DE
authors: Winchester
authors: Andrew
authors: A
authors: Kitchen
authors: John C
authors: JC
authors: Brandt
authors: Raman S
authors: RS
authors: Dusaj
authors: Salim S
authors: SS
authors: Virani
authors: Steven M
authors: SM
authors: Bradley
authors: Leslee J
authors: LJ
authors: Shaw
authors: Rebecca J
authors: RJ
authors: Beyth
mesh_terms: D000368:Aged; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000453:epidemiology; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000592:standards*; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D019564:Unnecessary Procedures / Q000706:statistics & numerical data*; D014600:Utilization Review; D058014:Veterans Health / Q000706:statistics & numerical data