Implementation of appropriate use criteria for cardiology tests and procedures: A systematic review and meta-analysis

David E. Winchester, Justin Merritt, Nida Waheed, Hannah Norton, Veena Manja, Nishant R. Shah, Christian D. Helfrich

Research output: Contribution to journalReview articlepeer-review

1 Scopus citations

Abstract

Aims: The American College of Cardiology appropriate use criteria (AUC) provide clinicians with evidence-informed recommendations for cardiac care. Adopting AUC into clinical workflows may present challenges, and there may be specific implementation strategies that are effective in promoting effective use of AUC. We sought to assess the effect of implementing AUC in clinical practice. Methods and results: We conducted a meta-analysis of studies found through a systematic search of the MEDLINE, Web of Science, Cochrane, or CINAHL databases. Peer-reviewed manuscripts published after 2005 that reported on the implementation of AUC for a cardiovascular test or procedure were included. The main outcome was to determine if AUC implementation was associated with a reduction in inappropriate/rarely appropriate care. Of the 18 included studies, the majority used pre/post-cohort designs; few (n = 3) were randomized trials. Most studies used multiple strategies (n = 12, 66.7%). Education was the most common individual intervention strategy (n = 13, 72.2%), followed by audit and feedback (n = 8, 44.4%) and computerized physician order entry (n = 6, 33.3%). No studies reported on formal use of stakeholder engagement or 'nudges'. In meta-analysis, AUC implementation was associated with a reduction in inappropriate/rarely appropriate care (odds ratio 0.62, 95% confidence interval 0.49-0.78). Funnel plot suggests the possibility of publication bias. Conclusion: We found most published efforts to implement AUC observed reductions in inappropriate/rarely appropriate care. Studies rarely explored how or why the implementation strategy was effective. Because interventions were infrequently tested in isolation, it is difficult to make observations about their effectiveness as stand-alone strategies.

Original languageEnglish (US)
Pages (from-to)34-41
Number of pages8
JournalEuropean heart journal. Quality of care & clinical outcomes
Volume7
Issue number1
DOIs
StatePublished - Jan 1 2021

Keywords

  • Appropriate use criteria
  • Cardiology
  • Implementation science
  • Meta-analysis
  • Systematic review

ASJC Scopus subject areas

  • Health Policy
  • Cardiology and Cardiovascular Medicine

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