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The Use of Quality Improvement Interventions in Reducing Rarely Appropriate Echocardiograms: A Systematic Review and Meta-Analysis
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  • Michael Tao,
  • Mohammed Al-Sadawi,
  • Navid Ahmed,
  • Neda Dianati-Maleki,
  • Noelle Mann,
  • Smadar Kort
Michael Tao
Stony Brook University Hospital
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Mohammed Al-Sadawi
Stony Brook University Hospital
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Navid Ahmed
Stony Brook University Hospital
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Neda Dianati-Maleki
Stony Brook University Hospital
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Noelle Mann
Stony Brook University Hospital
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Smadar Kort
Stony Brook University Hospital

Corresponding Author:[email protected]

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Background: As the volume of cardiac imaging continues to increase, so is the number of tests performed for rarely appropriate indications. Appropriate use criteria (AUC) documents were published by professional societies with quality improvement (QI) interventions developed in various institutions. However, the effectiveness of these interventions has not been assessed in a systematic fashion. Methods: We performed a database search for studies reporting the association between cardiac imaging, AUC and QI. We selected studies assessing the effect of QI interventions on performance of rarely appropriate echocardiograms. The primary endpoint was reduction of rarely appropriate testing. Results: Nine studies with 22,070 patients met inclusion criteria. QI interventions resulted in statistically significant reduction in rarely appropriate tests (OR 0.52, 95% CI 0.41-0.66; p<0.01). The effects of QI interventions were analyzed over both the short (< 3 months) and long-term (> 3 months) post intervention (OR 0.62, 95% CI: 0.49-0.79; p<0.01 in the short term, and OR 0.47, 95% CI: 0.35-0.62; p<0.01 in the long term). Subgroup analysis of the type of intervention, classified as education tools or decision support tools showed both significantly reduced rarely appropriate testing (OR 0.54, 95% CI: 0.41-0.73; p<0.01; OR 0.47, 95% CI: 0.36-0.61; p<0.01). Adding a feedback tool did not change the effect compared to not using a feedback tool (OR 0.49 vs. 0.57, 95% CI: 0.36-0.68 vs. 0.39-0.84; p>0.05). Conclusion: QI interventions are associated with a significant reduction in performance of rarely appropriate echocardiography testing, the effects of which persist over time.
20 Feb 2023Submitted to Echocardiography
23 Feb 2023Submission Checks Completed
23 Feb 2023Assigned to Editor
17 Mar 2023Reviewer(s) Assigned
07 Jun 2023Review(s) Completed, Editorial Evaluation Pending
15 Jun 2023Editorial Decision: Revise Major
16 Jun 20231st Revision Received
19 Jun 2023Submission Checks Completed
19 Jun 2023Assigned to Editor
19 Jun 2023Reviewer(s) Assigned
05 Jul 2023Review(s) Completed, Editorial Evaluation Pending
07 Jul 2023Editorial Decision: Accept