Effect of Patient-Specific Ratings vs Conventional Guidelines on Investigation Decisions in Angina

Junghans, Cornelia; Feder, Gene; Eldridge, Sandra; Black, Nick; Shekelle, Paul G; Hemingway, Harry

doi:10.1001/archinte.167.2.195

Cited by 21 publications

(16 citation statements)

References 27 publications

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“…Appropriateness criteria could also be used by physicians for clinical decision support or implemented in the clinical realm as part of the preoperative informed consent process, with patients receiving individualized assessments of the appropriateness of the procedure for their particular clinical scenario. For example, a proof of concept of the utility of appropriateness criteria for changing physician behavior and reducing practice variations was performed in the United Kingdom using criteria for coronary angiography [59]. These uses would be consistent with recent quality measures proposed by the Centers for Medicare and Medicaid Services for Accountable Care Organizations, which include a measure of the percentage of physicians using clinical decision support and a measure of shared decision-making between physician and patient.…”

Section: Discussionmentioning

confidence: 99%

The appropriateness method has acceptable reliability and validity for assessing overuse and underuse of surgical procedures

Lawson¹,

Gibbons²,

Ko³

et al. 2012

Journal of Clinical Epidemiology

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Section: Discussionmentioning

confidence: 99%

The appropriateness method has acceptable reliability and validity for assessing overuse and underuse of surgical procedures

Lawson¹,

Gibbons²,

Ko³

et al. 2012

Journal of Clinical Epidemiology

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“…Process changes were defined as smallscale changes to some aspect of the individual referral process that did not involve the movement of staff or relocation of clinics, the methods in which referrals were triaged at hospital, or financial arrangements for referral. Process change interventions included: designated appointment slots and fast-track clinics for primary care referrals (n = 6), [60][61][62][63][64][65] direct access to screening (n = 9), 66 to referral (individual contact between a specialist and GP) (n = 11), [75][76][77][78][79][80][81][82][83][84][85] electronic referral systems (n = 10), [86][87][88][89][90][91][92][93][94][95] decision support tools (n = 10), [96][97][98][99][100][101][102][103][104][105] and waiting list review or watchful waiting (n = 3). [106][107][108] The overall picture for interventions that aim to moderate referral outcomes by changing an element of the referral process is mixed.…”

Section: Box 1 Main Search Strategymentioning

confidence: 99%

Referral interventions from primary to specialist care: a systematic review of international evidence

et al. 2014

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BackgroundDemand management defines any method used to monitor, direct, or regulate patient referrals. Strategies have been developed to manage the referral of patients to secondary care, with interventions that target primary care, specialist services, or infrastructure. AimTo review the international evidence on interventions to manage referral from primary to specialist care. Design and settingSystematic review. MethodIterative, systematic searches of published and unpublished sources public health, health management, management, and grey literature databases from health care and other industries were undertaken to identify recent, relevant studies. A narrative synthesis of the data was completed to structure the evidence into groups of similar interventions. ResultsThe searches generated 8327 unique results, of which 140 studies were included. Interventions were grouped into four intervention categories: GP education (n = 50); process change (n = 49); system change (n = 38); and patient-focused (n = 3). It is clear that there is no 'magic bullet' to managing demand for secondary care services: although some groups of interventions may have greater potential for development, given the existing evidence that they can be effective in specific contexts.

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“…Application of that guidance to decision making about individual patients might help to address inequitable access to angiography for some groups of patients with recent onset chest pain. The potential of appropriate ratings for specific patients to improve investigative decisions for patients with chest pain 22 now needs to be tested in real clinical settings. Appropriateness ratings incorporated into decision support systems might have a wider application for investigative and treatment decisions in other clinical settings.…”

Section: Resultsmentioning

confidence: 99%

Inequity of access to investigation and effect on clinical outcomes: prognostic study of coronary angiography for suspected stable angina pectoris

2008

BMJ

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Objectives To determine whether coronary angiography for suspected stable angina pectoris is underused in older patients, women, south Asian patients, and those from socioeconomically deprived areas, and, if it is, whether this is associated with higher coronary event rates. Design Multicentre cohort with five year follow-up. Setting Six ambulatory care clinics in England. Participants 1375 consecutive patients in whom coronary angiography was individually rated as appropriate with the Rand consensus method. Main outcome measures Receipt of angiography (420 procedures); coronary mortality and acute coronary syndrome events.Results In a multivariable analysis, angiography was less likely to be performed in patients aged over 64 compared with those aged under 50 (hazard ratio 0.60, 95% confidence interval 0.38 to 0.96), women compared with men (0.42, 0.35 to 0.50), south Asians compared with white people (0.48, 0.34 to 0.67), and patients in the most deprived fifth compared with the other four fifths (0.66, 0.40 to 1.08). Not undergoing angiography when it was deemed appropriate was associated with higher rates of coronary event.Conclusions At an early stage after presentation with suspected angina, coronary angiography is underused in older people, women, south Asians, and people from deprived areas. Not receiving appropriate angiography was associated with a higher risk of coronary events in all groups. Interventions based on clinical guidance that supports individualised management decisions might improve access and outcomes.

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Effect of Patient-Specific Ratings vs Conventional Guidelines on Investigation Decisions in Angina

Cited by 21 publications

References 27 publications

The appropriateness method has acceptable reliability and validity for assessing overuse and underuse of surgical procedures

The appropriateness method has acceptable reliability and validity for assessing overuse and underuse of surgical procedures

Referral interventions from primary to specialist care: a systematic review of international evidence

Inequity of access to investigation and effect on clinical outcomes: prognostic study of coronary angiography for suspected stable angina pectoris

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