A Multi-centered Feedback and Education Intervention Designed to Reduce Inappropriate Transthoracic Echocardiograms

Status unconfirmed · Not applicable

Conditions studied: CARDIOVASCULAR DISEASES

In brief

This study is an international, prospective, multi-centred, investigator blinded, randomized control trial of an educational and feedback-based intervention vs. usual care to study the proportion of inappropriate TTEs ordered by clinicians in ambulatory care. The American College of Cardiology collaborated with the American Society of Echocardiography to develop its Appropriate Use Criteria (AUC) for Echocardiography in 2007, and were updated in 2011. We created an innovative education and feedback-based intervention that we hypothesize will reduce the proportion of inappropriate TTEs ordered in clinical practice. Our objective is to prospectively study the following intervention in a multicentre, randomized control trial format to determine if this intervention will reduce inappropriate TTEs and the number of TTEs ordered in practice. The study will take place at multiple hospitals in Canada the United States. Participants include cardiologists and primary care providers (both general internal medicine and family practice) who provide ambulatory care. Once cardiologists and primary care physicians are recruited for the study, they will be randomized into one of two arms: 1) Intervention group, 2) Control group. A physician's TTE ordering information will be ascertained by review of the individual TTE order and by review of the patient's medical record. Trained research coordinators at each site will review the TTE order for indication and review the patient record to ascertain clinical circumstances regarding the TTE order. The individual research coordinator will review this information using the 2011 AUC and classify the TTE as Appropriate (A), Inappropriate (I) or Uncertain (U), and assign the TTE order the most appropriate indication number accordingly. Research Coordinators will be blinded to which physicians are in the intervention or control group. Research Coordinators at each site will be responsible for individual physicians' TTE order classifications but will be blinded to study group. Once monthly TTE orders are classified and collated, this information will be transmitted to the central research laboratory, where a research coordinator will collate all of the results and transmit monthly feedback reports to individual physicians. The control group will order TTEs as is their usual practice.

Key facts

Study ID

NCT02038101

Run by

Women's College Hospital

People needed

256

Starts

2014-12-01

Expected to finish

2016-08-01

Last updated by the study team

2016-06-09

Who can join

Age: any. Sex: any. Healthy volunteers: accepted.

You may qualify if…

• Cardiologist or physician practicing Primary Care in the Ambulatory care

You may not qualify if…

• . Pediatric cardiologists and physicians who specialize primarily in adult congenital heart disease will be excluded from the study

Where it is running

• Massachusetts General Hospital — Boston, Massachusetts, United States
• Sunnybrook Health Sciences Centre — Toronto, Ontario, Canada
• Mount Sinai Hospital — Toronto, Ontario, Canada
• University Health Network — Toronto, Ontario, Canada
• Women's College Hospital — Toronto, Ontario, Canada
• Saint Michael's Hospital — Toronto, Ontario, Canada

Full record on ClinicalTrials.gov

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