Educational programs, increased physician collaboration can reduce inappropriate CCTA use

Appropriate use of testing is a hot topic in medicine as physicians and hospitals look for ways to improve quality while containing cost to achieve high-value care. This is especially true in the field of cardiology where the potential consequences of incorrect diagnosis have led to overuse of cardiovascular imaging with CT scanners, called coronary CT angiography.

A landmark study, led by Kavitha Chinnaiyan, M.D., director of Advanced Cardiac Imaging Education, Beaumont Health System, has shown that inappropriate CCTA use can be reduced by 60 percent with educational programs, increased physician collaboration, and close monitoring. The research is published in the Aug. 8 online issue of the Journal of the American College of Cardiology.

The results come from a multicenter, statewide quality improvement initiative called the Advanced Cardiovascular Imaging Consortium, sponsored by Blue Cross Blue Shield/Blue Care Network of Michigan. A total of 47 centers in Michigan took part in this ongoing initiative during the time period of this study (July 2007 to December 2010).

"We looked at more than 25,000 patients in the ACIC registry, reviewed data on appropriate use, then had a period of intervention with 5,000 referring physicians across the state offering educational programs, close monitoring and feedback to physicians on CT use," says Dr. Chinnaiyan, ACIC program director.

As coronary CT angiography is a relatively new imaging methodology, this statewide collaborative was formed in part to assess how providers should best utilize this technology, while at the same time reducing its inappropriate use. After the intervention, there was a follow-up period where appropriate use was reviewed again.

"We found that appropriate use increased and inappropriate use decreased by 60 percent across all referring physician specialties – including cardiologists, internists, emergency room physicians," says Dr. Chinnaiyan. "These are very exciting results for doctors, patients and for payers."

Coronary CT angiography is the fastest growing application of CT scanners in the U.S. About 500,000 Americans undergo CCTA each year at an average cost of $500 - $1500.

"The study suggests that voluntary, mutually established quality metrics reinforced by education and feedback can result in major changes in inappropriate use," notes Dr. Chinnaiyan. "This collaborative approach involving physicians, hospitals and payers may be applied beyond CCTA to enhance value in other areas of medicine."

The ACIC was launched by Blue Cross Blue Shield/Blue Care Network of Michigan in collaboration with Beaumont Health System in July 2007 as a collaborative quality initiative to improve the practice of coronary CT angiography. The initiative has generated many important findings on effective use of advanced cardiovascular imaging techniques. Beaumont is the coordinating center for the consortium.

"This is another exciting example of how hospitals and the Michigan Blues are supporting collaborative learning and partnership that leads to better care for patients in our state," says David Share, M.D., MPH, vice president and assistant chief medical officer, Blue Cross Blue Shield of Michigan. "The ACIC is one of 12 collaborations studying different aspects of patient care that the Michigan Blues support in partnership with more than 70 hospitals across the state."

Earlier this year, ACIC-generated research found that CCTA is more effective than cardiac stress testing at identifying heart disease requiring an expensive, invasive heart catheterization procedure. Dr. Chinnaiyan also authored that research published in the February 14 Journal of the American College of Cardiology.

Beaumont is a world leader in cardiac CT imaging, with other published research on the use of CT imaging for diagnosing or predicting heart attack; identifying unstable plaque likely to cause a heart attack; and diagnosing chest pain patients in the Emergency Center.