Trends in Troponin-Only Testing for AMI in Academic Teaching Hospitals and the Impact of Choosing Wisely®.
J Hosp Med
; 12(12): 957-962, 2017 12.
Article
em En
| MEDLINE
| ID: mdl-29236093
ABSTRACT
BACKGROUND:
Identifying hospitals that are both early and consistent adopters of high-value care can help shed light on the culture and practices at those institutions that are necessary to promote high-value care nationwide. The use of troponin to diagnose acute myocardial infarction (AMI), and not to test for myoglobin or creatine kinase-MB (CK-MB), is a high-value recommendation of the Choosing Wisely® campaign.OBJECTIVE:
To examine the variation in cardiac biomarker testing and the effect of the Choosing Wisely® troponin-only recommendation for the diagnosis of AMI.DESIGN:
A retrospective observational study using administrative ordering data from Vizient's Clinical Database/Resource Manager.SETTING:
Ninety-one academic medical centers from the fourth quarter of 2013 through the third quarter of 2016. PATIENTS Hospitalized patients with a principal discharge diagnosis of AMI. INTERVENTION The Choosing Wisely® recommendation to order troponin-only testing to diagnose AMI was released during the first quarter of 2015.RESULTS:
In 19 hospitals, troponin-only testing was consistently ordered to diagnose AMI before the Choosing Wisely® recommendation and throughout the study period. In 34 hospitals, both troponin and myoglobin/CK-MB were ordered to diagnose AMI even after the Choosing Wisely® recommendation. In 26 hospitals with low rates of troponin-only testing before the Choosing Wisely® recommendation, the release of the recommendation was associated with a statistically significant increase in the rate of troponin-only testing to diagnose AMI.CONCLUSIONS:
In institutions with low rates of troponin-only testing prior to the Choosing Wisely® recommendation, the recommendation was associated with a significant increase in the rate of troponin-only testing.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Troponina
/
Hospitais de Ensino
/
Infarto do Miocárdio
Tipo de estudo:
Guideline
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Humans
Idioma:
En
Revista:
J Hosp Med
Ano de publicação:
2017
Tipo de documento:
Article
País de afiliação:
Estados Unidos