A Third of Stress Echo Tests Found Inappropriate

A new study claims that according to revised criteria on the utilization of stress echocardiography (SE), one-third of stress-echocardiographic tests were ordered for unsuitable indications.

Researchers at the University of Miami (FL, USA) set out to evaluate the utilization of SE, the impact of the updated 2011 appropriate use criteria (AUC) on appropriateness ratings, the correlation of AUC to radiology benefits managers' (RBM) precertification guidelines, and the effect of temporal trends and an AUC-based educational project on appropriateness. To do so, they classified the appropriateness of SEs using the original and the updated AUC; they also performed preauthorization determinations on these SEs using the guidelines of two RBM precertification guidelines.

The researchers first classified and compared the appropriateness of 209 SEs from 2011 using the updated criteria to that of the 2008 cohort. Finally, they rated and compared 111 SEs requested by cardiologists after an educational project to 111 SEs referred before the intervention. The results showed that overall, the updated criteria do not appear to have had an impact on the number of tests requested for inappropriate reasons, resulting in approximately one-third of SE tests ordered for inappropriate indications. Referrals of unsuitable SE did not decrease over time or with an educational intervention.

In addition, the researchers found only a moderate degree of correlation between the 2008 and 2011 appropriate-use criteria for stress echocardiography and the RBM precertification guidelines. According to the study, 12.9% and 41.9% (respectively) of the SE cases classified as appropriate or uncertain using the 2008 criteria would not have received preauthorization. The authors suggested that the limited correlation between AUC ratings and RBM determinations suggests a need for greater consistency. The study was published online on February 20, 2013, in Cardiovascular Imaging.

“The revised criteria represent improvements that may potentially help clinicians as well as health plans using them in decision making. However, we were not able to demonstrate that the publication of the new appropriate-use criteria had a substantial impact on utilization practices, at least in our institution,” said lead author Howard Willens, MD. “Two iterations of the criteria, as well as a casual education initiative, did not impact utilization over a three-year period.”

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