Abstract 253: Variability in the Rates of Normal Diagnostic Coronary Catheterizations and Non-invasive Pre-catheterization Cardiac Diagnostic Testing in Ontario
Notice bibliographique
Résumé
The Cardiac Care Network of Ontario (CCN) serves as a system support to the Ministry of Health and Long Term Care as well as hospitals, and care providers in the province of Ontario, Canada. CCN is dedicated to improving the quality, efficiency, access and equity in the delivery of adult cardiovascular services in the province. CCN works to plan, coordinate, implement and evaluate adult cardiovascular care in Ontario, and is responsible for the CCN Cardiac Registry. Nineteen hospitals in Ontario perform diagnostic coronary catheterizations (CATH) and all enter data into the CCN Cardiac Registry. The objective of this analysis was to analyze temporal trends in the rates of CATH procedures across Ontario and examine in detail the rate of pre-CATH non-invasive cardiac diagnostic testing in patients who had normal or non-significant coronary artery disease (CAD) CATH results. CATH data in the CCN Cardiac Registry from patients with stable CAD in Ontario from fiscal years 2011/12 to 2014/15 were analyzed. Recognizing that non-elective CATH patients may present with acute symptoms that warrant immediate intervention and non-invasive cardiac diagnostic testing may not be appropriate, we excluded these patients from our analysis. We defined stable CAD as CATH patients assigned an urgency ranking of “Elective” or “Semi-Urgent” at the time of their procedure. From 2011/12 to 2014/15 the number of stable CAD CATH procedures performed in Ontario remained relatively unchanged, ranging between 29,000 and 30,000 procedures per year. The rate of CATH procedures in which the result was normal or non-significant CAD also remained stable, ranging from approximately 32 to 33.5% per year. Approximately 75% of all patients in this cohort received some type of pre-CATH non-invasive cardiac diagnostic test. Although these results remained relatively stable year-over-year at a provincial level, we identified considerable variation in these results between cardiac centres with centre-specific rates of normal CATHs ranging from 7% to 56% and the rate of pre-CATH diagnostic testing ranging from approximately 37% to 92%. While a proportion of CATH results are expected to be in the range of normal or non-significant CAD, the exact expected rate is undetermined. Our analysis revealed large variation in the rate of normal/non-significant CAD results between cardiac centres in Ontario, with several programs having a rate considerably higher than the provincial average. The appropriate use of non-invasive cardiac diagnostic testing in elective, stable patients prior to CATH requires additional evaluation as the quality of the diagnostic testing is uncertain. Equivocal and/or uncertain non-invasive diagnostic test results may prompt more patients with normal anatomy/non-significant disease to undergo CATH to render a definitive diagnosis. These present important opportunities for ongoing quality improvement.
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Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,004 | 0,021 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».