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American Society of Echocardiography News
AMERICAN SOCIE1Y OF ECHOCARDIOGRAPHY NEWS President's Message OUTCOMES RESEARCH Introduction As many of you are aware, the American Society of Echocardiography (ASE) considers one of its most important goals to be the sponsorship of research in echocardiography. We have 2 committees that deal with this area: the Research Committee, chaired by Dr Nat Pandian, and the Outcomes Research Committee, chaired by Dr Pamela Douglas. In this issue of JASE, Dr Douglas describes outcomes research and how it differs from research in general. Why should ASE devote resources and energy to support research, especially outcomes research? Simply put, our interests are served through the demonstration of the value of echocardiography in improving patient outcomes and through the documentation of its cost-effectiveness. As Dr Douglas lucidly explains, use of diagnostic techniques, reimbursement for professional and technical activities, and ultimately our professional livelihood, depend on such demonstrations-and such dependence will only increase in the age of managed health care. Richard E. Kerber, MD President American Society of Ecbocardiography
What Is Outcomes Research? In this era of cost consciousness in medicine, a primary concern of dedicated health care providers is the preservation of quality of care. Measurement of quality in medicine can be very difficult, though, especially in a diagnostic subspecialty such as echocardiography where patients' survival, or even recovery, cannot easily be linked directly to performance of cardiac ultrasonography. However, we need to justify its use to payers, administrators, guideline writers, and even referring physicians. We must be able to provide some data supporting the value of echocardiography. Research performed to identify this value is termed outcomes research because of its focus on the ultimate results of care for the patient. Closely linked to outcomes research is cost-effectiveness research, which attempts to evaluate which of 2 or more diagnostic or treatment options provides the best results at the lowest cost. Much of the research performed in echocardiography hinges on the technique's ability to identify pathology or to risk-stratify patients. While valuable, such investigations fall in the category of technology assessment and do not constitute outcomes research; risk stratification is not risk modification. Few data are available that address the utility of echocardiography. Yet payers, and increasingly providers, require demonstration of an improvement in patient status
as a result of testing. For example, we all "know" that patients with new-onset congestive heart failure need an echocardiogram (or another similar test) for the assessment of systolic function, but it is difficult to cite a chapter and verse in the medical literature that proves it. In the absence of such evidence, data-driven practice guidelines and reimbursement decisions may fail to award echocardiography the stature we feel it deserves.
What Is the American Society of Echocardiography Doing? In recognition of this knowledge gap, in 1993 the American Society of Echocardiography (ASE) created the Outcomes Research Committee to "explore opportunities to define the value of echocardiography in improving patient outcomes, and to foster additional research documenting the effectiveness and cost-effectiveness of echocardiography." The comminee has been busy, concentrating its efforts primarily on education and research. Our goals in these areas are as follows: -To increase the awareness and knowledge of the society's membership regarding outcomes and cost-effectiveness research and its value -To increase the visibility and quantity of outcomes research in echocardiography
18A Journal of the American Society of Echocardiography
Volume 11 Number 11
eTo identify high-priority areas where more research is needed eTo create and implement mechanisms for fostering such research -To increase funds available for support of such research eTo develop a critical mass of echocardiographers with skills appropriate to addressing health services-related questions, or of echocardiography-trained outcomes researchers. In its first year the Outcomes Research Committee sponsored a symposium at the ASE Scientific Sessions in 1994. Presentations by Drs Douglas,Wright, Kaul, and Gottdiener were well received, and symposium proceedings were published in JASE in 1996. Subsequently, an Outcomes Research Luncheon Session has occurred at nearly every national meeting. The 1998 luncheon focused on stress echocardiography and highlighted research and investigators funded by the ASE to perform research in this important area. Another educational initiative of the committee has been the creation of a twice-yearly Outcomes Research Review injASE. Debuting in the September 1998 issue, this feature surveys the literature and presents summaries and commentary on meritorious, recently published papers. The committee hopes the reviews will serve to heighten the awareness and knowledge of the ASE membership. ASE OUtcomes Research Grants On the research side, the Outcomes Research Committee has led the ASE into new territory as a funding agency. The committee, the ASE Board of Directors, and industry supporters all concurred that a critical need exists for more outcomes research in echocardiography and that together we could afford to fund such an undertaking. Industry sponsors and the ASE each contributed funds, and the Outcomes Research Grants Review Committee was created to oversee the process. Our first grant was awarded in 1996 to Karen Kuntz, ScD, and Kirsten E. Fleischmann, MD, MPH, for performance of a meta-analysis of test performance and a costeffective analysis comparing stress echocardiography with single-photon emission computed tomographic perfusion imaging. This project has produced several abstracts and structured session presentations at the American Heart Association (AHA) and American College of Cardiology (ACC) national meetings, as well as at the ASE Scientific Sessions. Manuscripts from this study are now in press at JAMA and Annals ofInternal Medicine, and data from the study are included in the upcoming AHA/ACC document "Practice Guidelines on Management of Chronic Stable Angina." This one study already has had tremendous impact, even though the papers have not been published yet! Since 19% we have funded 2 studies a year, for a total of 7 funded studies so far. A total of $371,000 has been awarded to support meritorious research. The investigators, their institutions, and the titles of their research are listed below:
1996 Karen M. Kuntz, ScD, Harvard School of Public Health
Volume II Number II
Kirsten E. Fleischmann, MD, MPH, Brigham and Women's Hospital "Cost-Effectiveness of Stress Echocardiography Using a Decision Analysis Model"
1997 Thomas K. Marwick, MD,The Cleveland Clinic Foundation "A Multicenter Study of the Prognostic Value and CostEffectiveness of Stress Echocardiography" Victor Davila-Roman, MD, Washington University "Noninvasive Preoperative Cardiac Evaluation of Patients Scheduled to Undergo Vascular Surgery: A Randomized Controlled Trial of Dobutamine Stress Echocardiography Versus Myocardial Perfusion Imaging"
1998 Allan L. Klein, MD, The Cleveland Clinic Foundation "Cost-Effectiveness ofTransesophageal Echocardiography to Guide Electrical Cardioversion in Patients with Atrial Fibrillation: The ACUTE Clinical Trial" Thomas R. Kimball, MD, Children's Hospital Medical Center, Cincinnati, Ohio "The Role of Echocardiography in the Evaluation of Heart Murmurs in Children: A Cost-Effectiveness Analysis"
1999 Vince G. Fowler, MD, Durham Veterans Medical Center "Identification of Candidates for Short-Course Therapy in Staphylococcus aureus Bacteremia: Cost-Effectiveness and Clinical Utility of Echocardiography in Selection of Patients" Anthony Sanfilippo, MD, Queens University, Kingston, Ontario, Canada "The Role of Stress Echocardiography in the Assessment ofWomen Presenting with Chest Pain" The grants application process has been streamlined and linked to the research and fellowship awards that the ASE now also offers, and the application process is advertised nationally by direct mailings,Web site postings, and journal advertisements. Applications are submitted by a variety of investigators, which indicates a growing interest in this area. Of note, our leadership and innovation has been recognized nationally. Three years after the ASE adopted dedicated funding for outcomes research, the AHA has followed suit, earmarking $6 million in its new Pharmaceutical Roundtable Initiative for outcomes and cost-effectiveness research. The committee's efforts in education and research are supported by ongoing initiatives in fund-raising and marketing. Highlighted in the July 1998 JASE President's Message was a new development initiative designed to increase funding for outcomes research, among other areas. Critically important to this initiative and to our entire effort in outcomes research has been the support of industry partners, whose generosity has made the grants process possible. Regular meetings between industry and ASE leadership ensure that the needs of all parties are met and that our partnerships will survive well into the future. A reconstituted Public Relations Committee, supplemented by the addition of a public affairs expert to the ASE staff,
Journal of the American Society of Echocardiography 19A
will help us spread the word about our outcomes research successes. Gradually, with the help of ASE membership, funded research, and industry partnerships, we are creating a body of research of the highest quality that can provide strong, objective support for the utility and cost-effectiveness of echocardiography. The next deadline for Outcomes Research Grant Application submissions is December 15, 1998.We are particularly interested in proposals related to contrast and
stress echocardiography, but all applications will be carefully considered on the basis of individual merit. Additional information may be obtained on the ASE Web site (asecho.org) or from the ASE office. Pamela S. Douglas, MD Chair Outcomes Research Committee American Society 0/ Echocardiography
Continuing Education and Meeting Calendar The American Society of Echocardiography recognizes courses as supplements to formal training in an established echocardiographic laboratory. For more information about a course, please call the number listed with the course. To list a course in the Continuing Education and Meeting Calendar, send the title, sponsor, director, place, and contact telephone number to ASE, Attn: Amy Berginski, 4101 Lake Boone Trail, Suite 201, Raleigh, NC 27607. Tel: (919)787-5181; e-mail: [email protected]. The Continuing Education and Meeting Calendar will display dates up to 1 year in advance. Ongoing courses, preceptorships, accredited programs, and schools will be listed only twice a year in January and July. Please refer to the ASE Web site, asecho.org, for full information.
1998 November 25-27. 10th Congress of the International Cardiac Doppler Society. Kagawa, Japan. Contact: Congress Office, Second Department of Internal Medicine, Kagawa Medical University, 1750-1 Miki, Kita, Kagawa 761-0793 Japan. Tel: 81-87-891-2150; fax: 81-87-891-2152; email: [email protected]. December 6-9. The 26th Annual Williamsburg Conference on Heart Disease. Williamsburg Lodge, Williamsburg, Va. Director: William e. Roberts, MD, FACC. Contact: American College of Cardiology. Tel: (800)253-4636, ext 695, or (301 )897-5400, ext 695; fax: (301)897-9745. December 9-12. Euroecho #2. Trieste, Italy. Sponsored by The Working Group on Echocardiography of the European Society of Cardiology. Director: Alessandro Distante, MD, FESC, FACe. Contact: ECOR-European Heart House, 2035 Route des Colles, Les Templiers BP 17906903 Sophia Antipolis, France. Tel: 33492947600; fax: 33-492947601; e-mail: [email protected]. December 10-13. Workshop on Echocardiography.
Bombay, India. Sponsored by the University of Alabama School of Medicine, UAB Division of CME, in cooperation with the International Society of Cardiovascular Ultrasound. Codirector: Navin e. Nanda, MD. Contact: Lindy Chapman or Martha Mann, UAB. Tel: (205)9348256; fax: (205 )934-6747; e-mail: [email protected]. December 11-13. Stress Echocardiography. Dallas, Tex. Sponsored by Keith Mauney & Associates. Contact: Tracy Heath, Director of Operations. Tel: (800)845-3484; fax: (888)335-3484. December 14-16. Advanced Echocardiography: Case Studies and Concepts. #1823. Directors: James D. Thomas, MD, FACC, and William 1. Stewart, MD, FACe. Sponsored by the American College of Cardiology. Contact: ACC, Heart House Learning Center. Tel: (800)253-4636 or (301)897-2652; fax: (301)897-9745. December 20-22. 6th International Congress on Noninvasive Cardiology. Jerusalem, Israel. Sponsored by the International Society & Federation of Cardiology, Israel Heart Association, International Society of Holter Monitoring and Noninvasive Electrophysiology. Codirectors: Dan Gilon, Ed Geltman, Richard Meltzer, Ronald Schwartz, Heinrich Schelbert, Zvi Vered. Contact: Organizing Secretariat. Tel: 972-3-5140000; fax: 972-3-5175674 or 5140077; e-mail: [email protected].
1999 January 11-13. Advanced Echocardiography: Illustrative Case Studies and Latest Techniques. # 1807. Directors: Julius M. Gardin, MD, FACC, and Natesa G. Pandian, MD. Sponsored by the American College of Cardiology. Contact: ACC, Heart House Learning Center. Tel: (800)253-4636 or (301)897-2652; fax: (301)897-9745. January 15-17. Update and Recent Advances in Echocardiography. Ponce Hilton Hotel, Ponce, Puerto Rico. Codirectors: Drs Navin e. Nanda and Ana Finch. Contact: Cardiovascular Association of the South. Tel: (787)844-2049, (787)844-2020, or (787)843-5542. January 25-29. Adult Echocardiography. Center for Medical Ultrasound, Wake Forest University School of
20A Journal of the American Society of Echocardiography
Volume 11 Number 11
What Is Outcomes Research? In this era of cost consciousness in medicine, a primary concern of dedicated health care providers is the preservation of quality of care. Measurement of quality in medicine can be very difficult, though, especially in a diagnostic subspecialty such as echocardiography where patients' survival, or even recovery, cannot easily be linked directly to performance of cardiac ultrasonography. However, we need to justify its use to payers, administrators, guideline writers, and even referring physicians. We must be able to provide some data supporting the value of echocardiography. Research performed to identify this value is termed outcomes research because of its focus on the ultimate results of care for the patient. Closely linked to outcomes research is cost-effectiveness research, which attempts to evaluate which of 2 or more diagnostic or treatment options provides the best results at the lowest cost. Much of the research performed in echocardiography hinges on the technique's ability to identify pathology or to risk-stratify patients. While valuable, such investigations fall in the category of technology assessment and do not constitute outcomes research; risk stratification is not risk modification. Few data are available that address the utility of echocardiography. Yet payers, and increasingly providers, require demonstration of an improvement in patient status
as a result of testing. For example, we all "know" that patients with new-onset congestive heart failure need an echocardiogram (or another similar test) for the assessment of systolic function, but it is difficult to cite a chapter and verse in the medical literature that proves it. In the absence of such evidence, data-driven practice guidelines and reimbursement decisions may fail to award echocardiography the stature we feel it deserves.
What Is the American Society of Echocardiography Doing? In recognition of this knowledge gap, in 1993 the American Society of Echocardiography (ASE) created the Outcomes Research Committee to "explore opportunities to define the value of echocardiography in improving patient outcomes, and to foster additional research documenting the effectiveness and cost-effectiveness of echocardiography." The comminee has been busy, concentrating its efforts primarily on education and research. Our goals in these areas are as follows: -To increase the awareness and knowledge of the society's membership regarding outcomes and cost-effectiveness research and its value -To increase the visibility and quantity of outcomes research in echocardiography
18A Journal of the American Society of Echocardiography
Volume 11 Number 11
eTo identify high-priority areas where more research is needed eTo create and implement mechanisms for fostering such research -To increase funds available for support of such research eTo develop a critical mass of echocardiographers with skills appropriate to addressing health services-related questions, or of echocardiography-trained outcomes researchers. In its first year the Outcomes Research Committee sponsored a symposium at the ASE Scientific Sessions in 1994. Presentations by Drs Douglas,Wright, Kaul, and Gottdiener were well received, and symposium proceedings were published in JASE in 1996. Subsequently, an Outcomes Research Luncheon Session has occurred at nearly every national meeting. The 1998 luncheon focused on stress echocardiography and highlighted research and investigators funded by the ASE to perform research in this important area. Another educational initiative of the committee has been the creation of a twice-yearly Outcomes Research Review injASE. Debuting in the September 1998 issue, this feature surveys the literature and presents summaries and commentary on meritorious, recently published papers. The committee hopes the reviews will serve to heighten the awareness and knowledge of the ASE membership. ASE OUtcomes Research Grants On the research side, the Outcomes Research Committee has led the ASE into new territory as a funding agency. The committee, the ASE Board of Directors, and industry supporters all concurred that a critical need exists for more outcomes research in echocardiography and that together we could afford to fund such an undertaking. Industry sponsors and the ASE each contributed funds, and the Outcomes Research Grants Review Committee was created to oversee the process. Our first grant was awarded in 1996 to Karen Kuntz, ScD, and Kirsten E. Fleischmann, MD, MPH, for performance of a meta-analysis of test performance and a costeffective analysis comparing stress echocardiography with single-photon emission computed tomographic perfusion imaging. This project has produced several abstracts and structured session presentations at the American Heart Association (AHA) and American College of Cardiology (ACC) national meetings, as well as at the ASE Scientific Sessions. Manuscripts from this study are now in press at JAMA and Annals ofInternal Medicine, and data from the study are included in the upcoming AHA/ACC document "Practice Guidelines on Management of Chronic Stable Angina." This one study already has had tremendous impact, even though the papers have not been published yet! Since 19% we have funded 2 studies a year, for a total of 7 funded studies so far. A total of $371,000 has been awarded to support meritorious research. The investigators, their institutions, and the titles of their research are listed below:
1996 Karen M. Kuntz, ScD, Harvard School of Public Health
Volume II Number II
Kirsten E. Fleischmann, MD, MPH, Brigham and Women's Hospital "Cost-Effectiveness of Stress Echocardiography Using a Decision Analysis Model"
1997 Thomas K. Marwick, MD,The Cleveland Clinic Foundation "A Multicenter Study of the Prognostic Value and CostEffectiveness of Stress Echocardiography" Victor Davila-Roman, MD, Washington University "Noninvasive Preoperative Cardiac Evaluation of Patients Scheduled to Undergo Vascular Surgery: A Randomized Controlled Trial of Dobutamine Stress Echocardiography Versus Myocardial Perfusion Imaging"
1998 Allan L. Klein, MD, The Cleveland Clinic Foundation "Cost-Effectiveness ofTransesophageal Echocardiography to Guide Electrical Cardioversion in Patients with Atrial Fibrillation: The ACUTE Clinical Trial" Thomas R. Kimball, MD, Children's Hospital Medical Center, Cincinnati, Ohio "The Role of Echocardiography in the Evaluation of Heart Murmurs in Children: A Cost-Effectiveness Analysis"
1999 Vince G. Fowler, MD, Durham Veterans Medical Center "Identification of Candidates for Short-Course Therapy in Staphylococcus aureus Bacteremia: Cost-Effectiveness and Clinical Utility of Echocardiography in Selection of Patients" Anthony Sanfilippo, MD, Queens University, Kingston, Ontario, Canada "The Role of Stress Echocardiography in the Assessment ofWomen Presenting with Chest Pain" The grants application process has been streamlined and linked to the research and fellowship awards that the ASE now also offers, and the application process is advertised nationally by direct mailings,Web site postings, and journal advertisements. Applications are submitted by a variety of investigators, which indicates a growing interest in this area. Of note, our leadership and innovation has been recognized nationally. Three years after the ASE adopted dedicated funding for outcomes research, the AHA has followed suit, earmarking $6 million in its new Pharmaceutical Roundtable Initiative for outcomes and cost-effectiveness research. The committee's efforts in education and research are supported by ongoing initiatives in fund-raising and marketing. Highlighted in the July 1998 JASE President's Message was a new development initiative designed to increase funding for outcomes research, among other areas. Critically important to this initiative and to our entire effort in outcomes research has been the support of industry partners, whose generosity has made the grants process possible. Regular meetings between industry and ASE leadership ensure that the needs of all parties are met and that our partnerships will survive well into the future. A reconstituted Public Relations Committee, supplemented by the addition of a public affairs expert to the ASE staff,
Journal of the American Society of Echocardiography 19A
will help us spread the word about our outcomes research successes. Gradually, with the help of ASE membership, funded research, and industry partnerships, we are creating a body of research of the highest quality that can provide strong, objective support for the utility and cost-effectiveness of echocardiography. The next deadline for Outcomes Research Grant Application submissions is December 15, 1998.We are particularly interested in proposals related to contrast and
stress echocardiography, but all applications will be carefully considered on the basis of individual merit. Additional information may be obtained on the ASE Web site (asecho.org) or from the ASE office. Pamela S. Douglas, MD Chair Outcomes Research Committee American Society 0/ Echocardiography
Continuing Education and Meeting Calendar The American Society of Echocardiography recognizes courses as supplements to formal training in an established echocardiographic laboratory. For more information about a course, please call the number listed with the course. To list a course in the Continuing Education and Meeting Calendar, send the title, sponsor, director, place, and contact telephone number to ASE, Attn: Amy Berginski, 4101 Lake Boone Trail, Suite 201, Raleigh, NC 27607. Tel: (919)787-5181; e-mail: [email protected]. The Continuing Education and Meeting Calendar will display dates up to 1 year in advance. Ongoing courses, preceptorships, accredited programs, and schools will be listed only twice a year in January and July. Please refer to the ASE Web site, asecho.org, for full information.
1998 November 25-27. 10th Congress of the International Cardiac Doppler Society. Kagawa, Japan. Contact: Congress Office, Second Department of Internal Medicine, Kagawa Medical University, 1750-1 Miki, Kita, Kagawa 761-0793 Japan. Tel: 81-87-891-2150; fax: 81-87-891-2152; email: [email protected]. December 6-9. The 26th Annual Williamsburg Conference on Heart Disease. Williamsburg Lodge, Williamsburg, Va. Director: William e. Roberts, MD, FACC. Contact: American College of Cardiology. Tel: (800)253-4636, ext 695, or (301 )897-5400, ext 695; fax: (301)897-9745. December 9-12. Euroecho #2. Trieste, Italy. Sponsored by The Working Group on Echocardiography of the European Society of Cardiology. Director: Alessandro Distante, MD, FESC, FACe. Contact: ECOR-European Heart House, 2035 Route des Colles, Les Templiers BP 17906903 Sophia Antipolis, France. Tel: 33492947600; fax: 33-492947601; e-mail: [email protected]. December 10-13. Workshop on Echocardiography.
Bombay, India. Sponsored by the University of Alabama School of Medicine, UAB Division of CME, in cooperation with the International Society of Cardiovascular Ultrasound. Codirector: Navin e. Nanda, MD. Contact: Lindy Chapman or Martha Mann, UAB. Tel: (205)9348256; fax: (205 )934-6747; e-mail: [email protected]. December 11-13. Stress Echocardiography. Dallas, Tex. Sponsored by Keith Mauney & Associates. Contact: Tracy Heath, Director of Operations. Tel: (800)845-3484; fax: (888)335-3484. December 14-16. Advanced Echocardiography: Case Studies and Concepts. #1823. Directors: James D. Thomas, MD, FACC, and William 1. Stewart, MD, FACe. Sponsored by the American College of Cardiology. Contact: ACC, Heart House Learning Center. Tel: (800)253-4636 or (301)897-2652; fax: (301)897-9745. December 20-22. 6th International Congress on Noninvasive Cardiology. Jerusalem, Israel. Sponsored by the International Society & Federation of Cardiology, Israel Heart Association, International Society of Holter Monitoring and Noninvasive Electrophysiology. Codirectors: Dan Gilon, Ed Geltman, Richard Meltzer, Ronald Schwartz, Heinrich Schelbert, Zvi Vered. Contact: Organizing Secretariat. Tel: 972-3-5140000; fax: 972-3-5175674 or 5140077; e-mail: [email protected].
1999 January 11-13. Advanced Echocardiography: Illustrative Case Studies and Latest Techniques. # 1807. Directors: Julius M. Gardin, MD, FACC, and Natesa G. Pandian, MD. Sponsored by the American College of Cardiology. Contact: ACC, Heart House Learning Center. Tel: (800)253-4636 or (301)897-2652; fax: (301)897-9745. January 15-17. Update and Recent Advances in Echocardiography. Ponce Hilton Hotel, Ponce, Puerto Rico. Codirectors: Drs Navin e. Nanda and Ana Finch. Contact: Cardiovascular Association of the South. Tel: (787)844-2049, (787)844-2020, or (787)843-5542. January 25-29. Adult Echocardiography. Center for Medical Ultrasound, Wake Forest University School of
20A Journal of the American Society of Echocardiography
Volume 11 Number 11