Comparison of echocardiography request appropriateness between public and private hospitals

Flávia Candolo Pupo Barbosa, Evandro Tinoco Mesquita, Laiz Baniziolli Barachi, Angelo Salgado, Rafael Kazuo, Maria Luiza Garcia Rosa, Claudio Tinoco Mesquita
Arquivos Brasileiros de Cardiologia 2011, 97 (4): 281-8

BACKGROUND: Aiming at improving the use of echocardiography tests, the Appropriateness Criteria (AC) were created by the American Society of Echocardiography (ASE)/American College of Cardiology (ACC).

OBJECTIVE: To compare the appropriateness profile of transthoracic echocardiography (TTE) requests in accordance with the AC, between a public University Hospital (UH) and a Private Hospital (PH), and verify which characteristics are associated with a better TTE request profile.

METHODS: We prospectively assessed 779 consecutive TTE requests in a PH (49.8%) and a UH (50.2%), with 55.6% of requests for women and 44.4% for men, aged 59.1 ± 15.7 years. The indications were classified as appropriate, inappropriate or non-classified, and adequacy to AC was correlated with age, patient gender, and the time since graduation of the requesting physician. The statistical analysis used Kappa coefficient and chi-square test.

RESULTS: There was no significant difference regarding the adequacy profile of appropriate TTE requests in the two institutions (71% vs. 75%, p = 0.3). At PH, the factors associated with higher rates of appropriate tests were: female gender (p = 0.001) and age younger than 60 years (p <0.001). In the UH, physicians who had graduated between 5 and 10 years before had a higher rate of inappropriate requests (p = 0.02). The variables that were independent predictors of appropriate tests in the PH were: female sex (p = 0.001) and age <60 years (p = 0.001).

CONCLUSION: In this evaluation, the PH and the UH profiles showed similar request appropriateness profiles. Female gender, time since graduation of the requesting physician and the patient's age influenced the appropriateness of requests.

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