Reducing Excess Cardiac Biomarker Testing at an Academic Medical Center

Marc R. Larochelle, Amy M. Knight, Hardin Pantle, Stefan Riedel, Jeffrey C. Trost

Research output: Contribution to journalArticle

Abstract

MAIN MEASURES: The primary outcome was percentage of patients with guideline-concordant ordering of cardiac biomarkers, defined as three or fewer troponin tests and zero CK-MB tests in patients without a diagnosis of ACS. Secondary outcomes included counts of tests ordered per patient, incidence of diagnosis of ACS, and estimated change in charges for cardiac biomarker tests in the post-intervention period.

KEY RESULTS: Twelve months following the intervention, we estimated that guideline-concordant ordering of cardiac biomarkers increased from 57.1 % to 95.5 %, an absolute increase of 38.4 % (95 % CI, 36.4 % to 40.4 %). We estimated that the intervention led to a 66 % reduction in the number of tests ordered, and a $1.25 million decrease in charges over the first year. At 12 months, there was an estimated absolute increase in incidence of primary diagnosis of ACS of 0.3 % (95 % CI, 0.0 % to 0.5 %) compared with the expected baseline rate.

CONCLUSIONS: We implemented a multimodal intervention that significantly increased guideline-concordant ordering of cardiac biomarker testing, leading to substantial reductions in tests ordered without impacting diagnostic yield. A trial of this approach at other institutions and for other diagnostic tests is warranted and if successful, would represent a framework for eliminating wasteful diagnostic testing.

BACKGROUND: Elimination of wasteful diagnostic testing will improve value for the United States health care system.

OBJECTIVE: Design and implement a multimodal intervention to improve evidence-based ordering of cardiac biomarkers for the diagnosis of acute coronary syndrome (ACS).

DESIGN: Interrupted times series.

SUBJECTS: A total of 60,494 adult inpatient admissions from January 2009 through July 2011 (pre-intervention) and 24,341 admissions from November 2011 through October 2012 (post-intervention) at an academic medical center in Baltimore, Maryland.

INTERVENTION: Multimodal intervention introduced August through October 2011 that included dissemination of an institutional guideline and changes to the computerized provider order entry system.

Original languageEnglish (US)
Pages (from-to)1468-1474
Number of pages7
JournalJournal of general internal medicine
Volume29
Issue number11
DOIs
StatePublished - Jan 1 2014

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Keywords

  • acute coronary syndrome
  • cardiac biomarkers
  • wasteful diagnostic testing

ASJC Scopus subject areas

  • Internal Medicine

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