title: Design and methods of the Echo WISELY (Will Inappropriate Scenarios for Echocardiography Lessen SignificantlY) study: An investigator-blinded randomized controlled trial of education and feedback intervention to reduce inappropriate echocardiograms.
abstract: BACKGROUND
  Appropriate use criteria (AUC) for transthoracic echocardiography (TTE) were developed to address concerns regarding inappropriate use of TTE. A previous pilot study suggests that an educational and feedback intervention can reduce inappropriate TTEs ordered by physicians in training. It is unknown if this type of intervention will be effective when targeted at attending level physicians in a variety of clinical settings.
  
  
  OBJECTIVE
  The aim of this international, multicenter study is to evaluate the hypothesis that an AUC-based educational and feedback intervention will reduce the proportion of inappropriate echocardiograms ordered by attending physicians in the ambulatory environment.
  
  
  METHODS
  In an ongoing multicentered, investigator-blinded, randomized controlled trial across Canada and the United States, cardiologists and primary care physicians practicing in the ambulatory setting will be enrolled. The intervention arm will receive (1) a lecture outlining the AUC and most recent available evidence highlighting appropriate use of TTE, (2) access to the American Society of Echocardiography mobile phone app, and (3) individualized feedback reports e-mailed monthly summarizing TTE ordering behavior including information on inappropriate TTEs and brief explanations of the inappropriate designation. The control group will receive no education on TTE appropriate use and order TTEs as usual practice.
  
  
  CONCLUSIONS
  The Echo WISELY (Will Inappropriate Scenarios for Echocardiography Lessen Significantly in an education RCT) study is the first multicenter randomized trial of an AUC-based educational intervention. The study will examine whether an education and feedback intervention will reduce the rate of outpatient inappropriate TTEs ordered by attending level cardiologists and primary care physicians (www.clinicaltrials.gov identifier NCT02038101).
authors: Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada; Peter Munk Cardiac Centre of the University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors: R Sacha
authors: RS
authors: Bhatia
authors: Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada; Department of Family and Community Medicine, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada; Cardiovascular Division, Brigham and Women's Hospital, Boston, MA.
authors: Noah
authors: N
authors: Ivers
authors: Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada.
authors: Cindy X
authors: CX
authors: Yin
authors: Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Canada.
authors: Dorothy
authors: D
authors: Myers
authors: Cardiology Division, Mount Sinai Hospital, Toronto, Ontario, Canada.
authors: Gillian
authors: G
authors: Nesbitt
authors: Echocardiogram and Vascular Lab, St Michael's Hospital, Toronto, Ontario, Canada.
authors: Jeremy
authors: J
authors: Edwards
authors: The Scarborough Hospital, Toronto, Ontario, Canada.
authors: Kibar
authors: K
authors: Yared
authors: Cardiovascular Division, Brigham and Women's Hospital, Boston, MA.
authors: Rishi
authors: R
authors: Wadhera
authors: Cardiovascular Division, Brigham and Women's Hospital, Boston, MA.
authors: Justina C
authors: JC
authors: Wu
authors: Sunnybrook Hospital, Toronto, Ontario, Canada.
authors: Brian
authors: B
authors: Wong
authors: Sunnybrook Hospital, Toronto, Ontario, Canada.
authors: Mark
authors: M
authors: Hansen
authors: Sunnybrook Hospital, Toronto, Ontario, Canada.
authors: Adina
authors: A
authors: Weinerman
authors: Sunnybrook Hospital, Toronto, Ontario, Canada.
authors: Steven
authors: S
authors: Shadowitz
authors: Queen's University, Kingston, Ontario, Canada.
authors: Amer
authors: A
authors: Johri
authors: Peter Munk Cardiac Centre of the University Health Network, University of Toronto, Toronto, Ontario, Canada; Cardiology Division, Mount Sinai Hospital, Toronto, Ontario, Canada.
authors: Michael
authors: M
authors: Farkouh
authors: Peter Munk Cardiac Centre of the University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors: Paaladinesh
authors: P
authors: Thavendiranathan
authors: Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada; Department of Family and Community Medicine, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada; Cardiovascular Division, Brigham and Women's Hospital, Boston, MA.
authors: Jacob A
authors: JA
authors: Udell
authors: Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada.
authors: Sherryn
authors: S
authors: Rambihar
authors: Echocardiogram and Vascular Lab, St Michael's Hospital, Toronto, Ontario, Canada.
authors: Chi-Ming
authors: CM
authors: Chow
authors: Cardiology Division, Mount Sinai Hospital, Toronto, Ontario, Canada.
authors: Judith
authors: J
authors: Hall
authors: Cardiology Division, Mount Sinai Hospital, Toronto, Ontario, Canada; Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Canada.
authors: Kevin E
authors: KE
authors: Thorpe
authors: Peter Munk Cardiac Centre of the University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors: Harry
authors: H
authors: Rakowski
authors: Cardiology Division, Massachusetts General Hospital, Boston, MA.
authors: Rory B
authors: RB
authors: Weiner
mesh_terms: D001291:Attitude of Health Personnel; D016507:Cardiology Service, Hospital / Q000706:statistics & numerical data*; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging*; D004452:Echocardiography / Q000592:standards* / Q000706:statistics & numerical data; D004501:Education, Medical / Q000379:methods*; D019983:Guideline Adherence; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008404:Massachusetts; D009864:Ontario; D010865:Pilot Projects; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D016037:Single-Blind Method; D019564:Unnecessary Procedures / Q000706:statistics & numerical data*