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OUTPATIENT EVALUATION OF INNOCENT MURMURS IN CHILDREN: UTILIZATION BENCHMARKING.
A44.E427 JACC March 9, 2010 Volume 55, issue 10A
CONGENITAL CARDIOLOGY SOLUTIONS (PEDIATRIC CARDIOLOGY AND ADULT CONGENITAL HEART DISEASE) OUTPATIENT EVALUATION OF INNOCENT MURMURS IN CHILDREN: UTILIZATION BENCHMARKING. ACC Poster Contributions Georgia World Congress Center, Hall B5 Monday, March 15, 2010, 3:30 p.m.-4:30 p.m.
Session Title: Practical Issues in Pediatric Cardiology Abstract Category: Pediatric Cardiology Presentation Number: 1229-403 Authors: Patrick A. Frias, Dara A. Rastegar, William T. Cole, William T. Mahle, Children’s Healthcare of Atlanta Sibley Heart Center, Atlanta, GA, Emory University School of Medicine, Atlanta, GA Background: Appropriate utilization of medical technology is a key component of any successful reform to the US healthcare delivery system. While criteria exist for appropriate use of echocardiography (echo), there exist no utilization benchmarking data for the pediatric population. We sought to evaluate the utilization of echo for the primary diagnosis (1º dx) of innocent murmur in a single-center pediatric cardiology practice. Methods: A retrospective 20-yr review of internal claims data was performed. Patients (pts) evaluated in our permanent or outreach clinics and discharged with a 1º dx of innocent murmur (ICD-9 785.2) were included in our evaluation. Echo utilization was determined for the entire practice and further subdivided for physician age, era of cardiology practice (1990-1999 and 2000-2009), and era of physician training as relates to workhour rules. Multivariate regression analysis was performed to identify factors associated with echo utilization. Results: From January 1990 - August 31, 2009, there were 147,509 unique pts evaluated in our outpatient clinics (319,450 visits, 44 physicians). 43,240 pts were discharged with a 1º dx of innocent murmur, and 17,117 underwent echo (45.6+18.6% echo rate). Physicians at or above the median age (51 yrs) as of this analysis had a utilization rate of 35.6%, compared to 56.2% for those below the median age (p=0.02). Training after the institution of work-hour rules was not independently associated with echo utilization. There was a marked increase in the echo utilization rate from 1990-99 to 2000-09, 23.6% vs. 48.2%, respectively, p<0.01. Conclusion: For this large, single-center pediatric cardiology practice, the overall echo utilization rate was 45.6% for unique pts discharged with a 1º dx of innocent murmur. Increasing physician age is inversely related to echo utilization, though all practitioners demonstrated increased utilization over time. This increased utilization likely represents technology availability, parent/family concern, and increased referral patterns primary care providers, and underscores the need for appropriateness criteria and utilization benchmark data.
CONGENITAL CARDIOLOGY SOLUTIONS (PEDIATRIC CARDIOLOGY AND ADULT CONGENITAL HEART DISEASE) OUTPATIENT EVALUATION OF INNOCENT MURMURS IN CHILDREN: UTILIZATION BENCHMARKING. ACC Poster Contributions Georgia World Congress Center, Hall B5 Monday, March 15, 2010, 3:30 p.m.-4:30 p.m.
Session Title: Practical Issues in Pediatric Cardiology Abstract Category: Pediatric Cardiology Presentation Number: 1229-403 Authors: Patrick A. Frias, Dara A. Rastegar, William T. Cole, William T. Mahle, Children’s Healthcare of Atlanta Sibley Heart Center, Atlanta, GA, Emory University School of Medicine, Atlanta, GA Background: Appropriate utilization of medical technology is a key component of any successful reform to the US healthcare delivery system. While criteria exist for appropriate use of echocardiography (echo), there exist no utilization benchmarking data for the pediatric population. We sought to evaluate the utilization of echo for the primary diagnosis (1º dx) of innocent murmur in a single-center pediatric cardiology practice. Methods: A retrospective 20-yr review of internal claims data was performed. Patients (pts) evaluated in our permanent or outreach clinics and discharged with a 1º dx of innocent murmur (ICD-9 785.2) were included in our evaluation. Echo utilization was determined for the entire practice and further subdivided for physician age, era of cardiology practice (1990-1999 and 2000-2009), and era of physician training as relates to workhour rules. Multivariate regression analysis was performed to identify factors associated with echo utilization. Results: From January 1990 - August 31, 2009, there were 147,509 unique pts evaluated in our outpatient clinics (319,450 visits, 44 physicians). 43,240 pts were discharged with a 1º dx of innocent murmur, and 17,117 underwent echo (45.6+18.6% echo rate). Physicians at or above the median age (51 yrs) as of this analysis had a utilization rate of 35.6%, compared to 56.2% for those below the median age (p=0.02). Training after the institution of work-hour rules was not independently associated with echo utilization. There was a marked increase in the echo utilization rate from 1990-99 to 2000-09, 23.6% vs. 48.2%, respectively, p<0.01. Conclusion: For this large, single-center pediatric cardiology practice, the overall echo utilization rate was 45.6% for unique pts discharged with a 1º dx of innocent murmur. Increasing physician age is inversely related to echo utilization, though all practitioners demonstrated increased utilization over time. This increased utilization likely represents technology availability, parent/family concern, and increased referral patterns primary care providers, and underscores the need for appropriateness criteria and utilization benchmark data.