Abstract P231: A National Initiative to Improve Utilization of Cardiac Imaging: The FOCUS Learning Community and Performance Improvement Module

Abstract

Background: The growth of medical imaging has placed burdens on healthcare finance and raised questions about quality of care. Resource sensitive and quality-centered imaging begins with the selection of the appropriate patient and test. Appropriate use criteria have been developed to aid clinicians but are often not in an easily accessible format. Objective: FOCUS, a web-based community, quality improvement, and education product, was developed to reduce inappropriate imaging by 15% in one year and by 50% within three years. Methods: Voluntary data collection occurred from April 2010 to January 2011 through the FOCUS Radionuclide Imaging Performance Improvement Module (PIM). The PIM consisted of three stages. In the first stage, participants entered patient cases (prospective or retrospective) to establish a baseline. Appropriate use was measured based on the 2009 RNI Appropriate Use Criteria using a computer based algorithm. Stage 2 featured the development of an action plan and incorporated quality improvement activities to support appropriate use of imaging. Patient cases were entered both at the end of stage 2, to check the participants progress, and in stage 3 (which is currently in progress), to evaluate the intervention period. Appropriate, inappropriate, and uncertain levels were compared between phases of the PIM. Results: For the 23 participating sites that had completed the two stages the proportion of inappropriate cases decreased from 10 %( 75/765) to 5 %( 33/609), for an overall decrease of 50% (p < .01) (See Table) . Conclusions: The data suggests that through the use of a self-directed, quality improvement software and interactive community, such as the FOCUS PIM, physicians can significantly decrease the proportion of tests not meeting appropriate use. This table displays the changes seen in appropriateness between stage 1 and stage 2 Patient Cases Stage 1 Stage 2 % Stage 1 % Stage 2 % Relative Change Appropriate 633 535 83% 88% +6% Innappropriate 75 33 10% 5% -50% Uncertain 57 41 7% 7% No Change TOTAL 765 609 100% 100%