Applying Criterion-Based Indications for Vascular Ultrasound Studies: Planning Quality Improvement
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Notice bibliographique
Résumé
Introduction Although most ultrasound facilities rely on the referring physicians' request for testing, inappropriate indications for ultrasound studies have been cited as a quality metric and source of poor resource use. In 2015, the Intersocietal Accreditation Commission mandated that ultrasound facilities undertake educational and other strategies to address this as a quality improvement initiative, including education of referring physicians. We proposed to study the indications noted in referrals to develop such quality strategies. Methods Dedicated vascular ultrasound facilities were asked to participate. An electronic search of guidelines, standards, and criteria for testing was done. The indication for testing in consecutive patients was collated with adherence to standards and criteria for testing, type of referring physician, patient demographics, and findings. Care gaps were identified to serve as a “needs assessment” for educational and other strategies to address quality improvement. Results Three facilities agreed to participate (one academic, two community). A total of 4,654 studies were analyzed. The vascular domains included were: carotid (610), aorta (217), renal (52), upper extremity arteries (56), lower extremity arteries (1,465), lower extremity venous for deep venous thrombosis (1,377), and lower extremity venous for chronic venous insufficiency (877). Overall, appropriate criteria were cited for 76–96% of studies; the academic facility had higher adherence. There was no difference between family physician and specialist referrals. Diagnostic positive yields were found in 48–68% in different test categories; aortic screening yield was 8.1%. Specific “teaching points” included “headaches” and “neck pain” for carotid studies, aortic screening outside of “targets,” “numb toes,” and “swelling” for arterial duplex; no clear issues were identified for venous studies. Conclusions This study does identify inappropriate indications for vascular ultrasound with no systematic findings. There are specific teaching points that can be used to direct educational strategies for referring physicians.
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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 | 0,003 | 0,004 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,003 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,001 | 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)
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Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
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