Comparison of Initial Pediatric Outpatient Echocardiogram Indications between Community and Academic Practice

To compare the appropriateness and diagnostic yield of initial outpatient transthoracic echocardiography (TTE) between a community pediatric cardiology practice and an academic children's hospital. Initial outpatient pediatric TTE ordered by pediatric cardiologists between January and March 201...

Full description

Saved in:
Bibliographic Details
Published in:The Journal of pediatrics 2019-04, Vol.207, p.23-28.e2
Main Authors: Balasubramanian, Sowmya, Ramirez, Faustine D., Bui, Yen, Selamet Tierney, Elif Seda, Behera, Sarina K.
Format: Article
Language:English
Subjects:
Academic Medical Centers - statistics & numerical data
Adolescent
appropriate use criteria
Cardiovascular Diseases - diagnostic imaging
Child
Child, Preschool
Community Health Centers - statistics & numerical data
echocardiogram
Echocardiography - standards
Echocardiography - statistics & numerical data
Female
Guideline Adherence
Hospitals, Pediatric - statistics & numerical data
Humans
Infant
Male
outpatient
Practice Patterns, Physicians' - statistics & numerical data
resource utilization
Retrospective Studies
Unnecessary Procedures - statistics & numerical data
Citations: Items that this one cites
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:To compare the appropriateness and diagnostic yield of initial outpatient transthoracic echocardiography (TTE) between a community pediatric cardiology practice and an academic children's hospital. Initial outpatient pediatric TTE ordered by pediatric cardiologists between January and March 2014 at a community practice (Packard Children's Health Alliance [PCHA]; n = 238) and an academic tertiary center (Lucile Packard Children's Hospital [LPCH]; n = 76) were evaluated based on appropriate use criteria (AUC) released in December 2014. Multivariate logistic regression was used to identify predictors of “rarely appropriate” indications and abnormal TTE findings. Of 314 TTEs, 165 (52.5%) were classified as “appropriate,” 40 (12.7%) were classified as “may be appropriate,” 100 (31.9%) were classified as “rarely appropriate,” and 9 (2.9%) were unclassifiable. The proportion of abnormal findings did not differ between the 2 practice settings (5.3% for LPCH vs 7.6% for PCHA; P = .61). TTEs performed at PCHA were significantly more likely to be “rarely appropriate” (OR, 2.57; 95% CI, 1.28-5.15; P = .008). Children aged
ISSN:0022-3476
1097-6833
DOI:10.1016/j.jpeds.2018.11.057