Web-based program helps sites cut inappropriate imaging

Sites that completed a web-based community and quality improvement project reduced rates of inappropriate imaging from 10 percent to 5 percent.

Samira Saifi, MHA, of Washington Hospital Center in Washington, D.C., and colleagues reported the results for a proof-of-concept study to assess the American College of Cardiology’s project, FOCUS (Formation of Optimal Cardiovascular Utilization Strategies). FOCUS was designed to help physicians select the right patient and right radionuclide imaging test based on appropriate use criteria. The project included feedback, education and the ability to interact online.

FOCUS used a self-paced program improvement module that was broken into three stages: entry of at least 10 consecutive patient cases to establish a baseline; creating an action plan with quality improvement objectives; and at least 30 days later, entering additional consecutive patients to re-evaluate performance and to track changes. Participants completed an evaluation survey after each phase and received reports with appropriate use criteria rates with a breakdown of clinical scenarios for inappropriate cases.

The program was launched January 2010 and the researchers started data collection in April 2010. By December 2011, 521 sites had enrolled in FOCUS. Of those, 362 were in stage one, 104 in stage two and 55 in stage three.  Of the 221 that completed stage one, 80 percent of studies were appropriate, 9 percent were uncertain and 11 percent inappropriate.

The 55 sites that competed stage three by December 2011 started with an inappropriate rate of 10 percent, which dropped to 5 percent. Their appropriate use rate rose from 82 percent to 89 percent. Eighty-seven percent of the sites improved or remained the same, and most of those that were unchanged had a 0 percent inappropriate use rate at baseline and at the end of stage three. Thirteen percent showed an increase in their rate of inappropriate testing.

“The FOCUS unique performance improvement module combines data review and education with physician interaction. Physicians are required to share questions and experiences with the FOCUS listserv or on the FOCUS Web community page. This provides physicians with a platform to exchange best practices and share tips and ideas that have led to success,” Saifi et al wrote.

They observed that nurses, technicians and other personnel also used communication aspects of the project and applied what they learned to their own practices as well as shared it with colleagues.

The most improvement occurred between stage two and three, after participants identified opportunities for improvement and developed an action plan. They added that some cases identified as inappropriate would be expected because appropriate use criteria cannot account for all clinical scenarios.

They acknowledged that participation in the study was voluntary and participants, as early adopters, might be more motivated than practices in general. The ACC is expanding FOCUS to include decision support software that can be accessed online or integrated with an EHR.

The study was published online May 1 in the Journal of the American College of Cardiology Cardiovascular Imaging.

For more on appropriate use in cardiovascular imaging and FOCUS, please read “Self-regulation through Appropriate Use.”