on February 17, 2012 |
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Topics: Electrophysiology, Cardiovascular, Service Lines
Jake Hartman
In an era increasingly defined by provider accountability for the cost and quality of care, ensuring appropriate care delivery is a top priority for CV administrators. Yet even as efforts to hardwire evidence-based guidelines accelerate nationwide, a recent survey published in Heart Rhythm suggests that getting referring physicians up to speed on ordering guidelines may be an equally significant challenge, with a third of referring physicians failing to adhere to ICD guidelines published by the ACC, AHA and Heart Rhythm Society.
A notable lack of adherence
The survey, conducted by researchers at the University of California, San Francisco, polled 3,000 physicians over six months in 2009. The random sample was comprised of one-third family medicine physicians, one-third internal medicine physicians, and one-third general cardiologists, all of whom were graduates of US medical schools. The survey itself was comprised of 34 questions evaluating the physicians’ referral habits in sending at-risk patients to a subspecialist for an ICD consult.
Of those surveyed, 28% reported that they never refer patients to a subspecialist to be considered for a primary prevention ICD, including 7% of cardiologists. On more specific measures, performance was mixed; only 15% of physicians assumed that a ventricular arrhythmia was required before referring a primary prevention ICD, while 36% believed that an ejection fraction of greater than 40% was necessary to warrant an ICD.
Taking stock of the problem
Overall, cardiologists performed significantly better than the family practitioners and internal medicine physicians with respect to guideline adherence. Nevertheless, the prevalence of discordant ordering behaviors is certainly troubling, in particular given the degree of consensus on referring criteria. The researchers cite a lack of awareness or understanding of the guidelines as a major factor inhibiting appropriate ordering, and hope that the survey will serve as a first step in identifying the root of these shortcomings.
Given the importance of securing appropriate use in the ordering of CV procedures, this survey provides an interesting challenge for hospital leaders. While the preponderance of our efforts to this point have focused on securing appropriate ordering in the hospital setting, providing the best longitudinal care to our patients may require more outreach to referring physicians to ensure that they are aware of, and relying upon, consensus ordering criteria.
For more on appropriate use and its pending impact on the cardiology business, members may register for our national meeting series, in which our Cardiovascular Market Report for 2011 addresses the growing necessity of instilling appropriate ordering criteria.
