@Article{chd.12679,
AUTHOR = {Shae Anderson, Courtney E. McCracken, Ritu Sachdeva},
TITLE = {Appropriateness of pediatric outpatient transthoracic echocardiogram orders following cessation of an active educational intervention},
JOURNAL = {Structural and Congenital Heart Disease},
VOLUME = {13},
YEAR = {2018},
NUMBER = {6},
PAGES = {1050--1057},
URL = {http://www.techscience.com/schd/v13n6/39088},
ISSN = {3071-1738},
ABSTRACT = {<b>Objective:</b> The educational intervention (EI) through the Pediatric Appropriate Use 
of Echocardiography (PAUSE) multicenter study resulted in improved appropriate‐
ness of transthoracic echocardiogram (TTE) orders at our center. The current study 
evaluated if this pattern persisted after cessation of EI and the potential physician 
characteristics influencing appropriateness.<br/>
<b>Design:</b> Outpatients (≤18 years old) seen for initial evaluation during the EI (July to 
October, 2015) and 6‐month post‐EI (May to August, 2016) phases were included. 
Comparison was made between TTE rates and appropriateness ratings during EI and 
post‐EI phase. Association between TTE rate and appropriateness with physician 
characteristics (age, experience, patient volume, and area of practice) was deter‐
mined using odds ratio.<br/>
<b>Results:</b> The study included 7781 patients (EI: N = 4016; post‐EI: N = 3765) seen by 
31 physicians. Comparison of appropriateness ratings in a randomized sample (EI: 
N = 1270; post‐EI: N = 1325 patients) showed no significant differences between the 
two phases (appropriate: 75.2% vs 74.9%, P = .960; rarely appropriate 4.1% vs 6.5%, 
P = .065). Though there was significant variability among physicians for TTE order 
appropriateness (P = .044) and ordering rate (P < .001), none of their characteristics 
were associated with appropriateness and only a higher patient volume was associ‐
ated with decreased odds of TTE ordering (OR = 0.7).<br/>
<b>Conclusion:</b> The PAUSE study EI resulted in maintaining appropriate utilization of 
TTEs at our center for 6 months following its cessation. Though not statistically sig‐
nificant, there was a trend toward increase in the proportion of studies for indica‐
tions designated rarely appropriate (R). There was significant physician variability in 
TTE ordering and appropriateness during both phases. Development of EI to reduce 
physician variability and integration of EI with provider workflow may help sustain 
appropriate TTE utilization.},
DOI = {10.1111/chd.12679}
}