title: Outpatient echocardiography in the evaluation of innocent murmurs in children: utilisation benchmarking.
abstract: OBJECTIVE
  We sought to benchmark the utilisation of echocardiography in the outpatient evaluation of heart murmurs by evaluating two large paediatric cardiology centres.
  
  
  BACKGROUND
  Although criteria exist for appropriate use of echocardiography, there are no benchmarking data demonstrating its utilisation.
  
  
  METHODS
  We performed a retrospective cohort study of outpatients aged between 0 and 18 years at the Sibley Heart Center Cardiology and the Children's Hospital of Philadelphia Division of Cardiology, given a sole diagnosis of "innocent murmur" from 1 July, 2007 to 31 October, 2010. Using internal claims data, we compared the utilisation of echocardiography according to centre, patient age, and physician years of service.
  
  
  RESULTS
  Of 23,114 eligible patients (Sibley Heart Center Cardiology: 12,815, Children's Hospital of Philadelphia Division of Cardiology: 10,299), 43.1% (Sibley Heart Center Cardiology: 45.2%, Children's Hospital of Philadelphia Division of Cardiology: 40.4%; p1-5 years had the lowest utilisation (32.7%).
  
  
  CONCLUSIONS
  In two large paediatric cardiology practices, the overall utilisation of echocardiography by physicians with a sole diagnosis of innocent murmur was similar. There was significant and similar variability in utilisation by provider at both centres. Although these data serve as initial benchmarking, the variability in utilisation highlights the importance of appropriate use criteria.
authors.affiliation: 1Children's Healthcare of Atlanta Sibley Heart Center,Department of Pediatrics,Emory University School of Medicine,Atlanta,Georgia,United States of America.
authors.forename: Patricio A
authors.initials: PA
authors.lastname: Frias
authors.affiliation: 1Children's Healthcare of Atlanta Sibley Heart Center,Department of Pediatrics,Emory University School of Medicine,Atlanta,Georgia,United States of America.
authors.forename: Matthew
authors.initials: M
authors.lastname: Oster
authors.affiliation: 2Children's Hospital of Philadelphia,University of Pennsylvania School of Medicine,Philadelphia,Pennsylvania,United States of America.
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Daley
authors.affiliation: 2Children's Hospital of Philadelphia,University of Pennsylvania School of Medicine,Philadelphia,Pennsylvania,United States of America.
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Boris
mesh_terms: D000293:Adolescent; D019985:Benchmarking; D002648:Child; D002675:Child, Preschool; D004452:Echocardiography / Q000706:statistics & numerical data*; D005260:Female; D006337:Heart Murmurs / Q000000981:diagnostic imaging*; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010045:Outpatients; D015143:Philadelphia; D012017:Referral and Consultation; D012189:Retrospective Studies
keywords: Practice management; benchmark; best practice; paediatric cardiology