Provider Feedback; Payer Reimbursement Key to Improving Appropriate Use of CCTA

Application of a systematic continuous quality improvement initiative, coupled with emphasis on a potential loss of coverage, is associated with a significant improvement in appropriate use of coronary computed tomography angiography (CCTA) across referring physician specialties, according to a new study published in the Journal of the American College of Cardiology (JACC).


As part of the study, which tracked 25, 387 patients enrolled in the Advanced Cardiovascular Imaging Consortium (ACIC) at 47 Michigan hospitals, referring physicians were provided with continuous education regarding CCTA appropriate use criteria (AUC). In addition, the possibility of losing third-party payer coverage in the absence of a measurable change in AUC application was emphasized. According to the study authors, this continuous feedback and collaboration with payers proved successful with a 23.4 percent increase in appropriate CCTA exams, 60.3 percent decrease in inappropriate exams, and a 40.8 percent decrease in uncertain exams between the pre-intervention and follow-up periods.  Change in CCTA referrals by specialty were as follows:

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The study aimed to "examine the trends in serum lipid concentrations" and found "among youths aged 6 to 19 years between 1988-1994 and 2007-2010, there was a decrease in mean TC (from 165 mg/dL [95 percent CI, 164-167] to 160 mg/dL [95 percent CI, 158-161]; P < .001) and a decrease in the prevalence of elevated TC (from 11.3 percent [95 percent CI, 9.8 percent – 12.7 percent] to 8.1 percent [95 percent CI, 6.7 percent – 9.5 percent]; P = .002)."

However, adverse lipid profiles continue to be observed among youths, and "in 2007-2010, slightly more than 20 percent of children aged 9-11 years had either a low HDL-C or high non-HDL-C concentration, which according to the most recent cardiovascular health guidelines for children and adolescents, indicates a need for additional clinical evaluation," note the authors.


The cross-sectional analysis was "the first study to measure serum lipid concentrations among youths in a nationally representative sample of the U.S. population" for as long as the National Health and Nutrition Examinations Surveys (NHANES), and looked 16,116 youths during three time periods: 1988-1994, 1999-2002, and 2007-2010.

"Improvements in child and adolescent lipid values over the past two decades are significant and may portend improved cardiovascular disease outcomes for the future, but much work should be done to better understand the changes and to build upon them," notes Sarah D. de Ferranti, MD, MPH, from the Harvard Medical School and Boston Children's Hospital in Boston, Mass., in an editorial comment.

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