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Deprecated: Implicit conversion from float 243.2 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 J+Hosp+Med 2017 ; 12 (12): 957-62 Nephropedia Template TP
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Trends in Troponin-Only Testing for AMI in Academic Teaching Hospitals and the Impact of Choosing WiselyŽ #MMPMID29236093
Prochaska MT; Hohmann SF; Modes M; Arora VM
J Hosp Med 2017[Dec]; 12 (12): 957-62 PMID29236093show ga
BACKGROUND: Identifying hospitals that are both early and consistent adopters of high-value care can help shed light on the culture and practices at those institutions that are necessary to promote high-value care nationwide. The use of troponin to diagnose acute myocardial infarction (AMI), and not to test for myoglobin or creatine kinase-MB (CK-MB), is a high-value recommendation of the Choosing WiselyŽ campaign. OBJECTIVE: To examine the variation in cardiac biomarker testing and the effect of the Choosing WiselyŽ troponin-only recommendation for the diagnosis of AMI. DESIGN: A retrospective observational study using administrative ordering data from Vizient?s Clinical Database/Resource Manager. SETTING: Ninety-one academic medical centers from the fourth quarter of 2013 through the third quarter of 2016. PATIENTS: Hospitalized patients with a principal discharge diagnosis of AMI. INTERVENTION: The Choosing WiselyŽ recommendation to order troponin-only testing to diagnose AMI was released during the first quarter of 2015. RESULTS: In 19 hospitals, troponin-only testing was consistently ordered to diagnose AMI before the Choosing WiselyŽ recommendation and throughout the study period. In 34 hospitals, both troponin and myoglobin/CK-MB were ordered to diagnose AMI even after the Choosing WiselyŽ recommendation. In 26 hospitals with low rates of troponin-only testing before the Choosing WiselyŽ recommendation, the release of the recommendation was associated with a statistically significant increase in the rate of troponin-only testing to diagnose AMI. CONCLUSION: In institutions with low rates of troponin-only testing prior to the Choosing WiselyŽ recommendation, the recommendation was associated with a significant increase in the rate of troponin-only testing.