The impact of performance feedback reports on physician ordering behavior in the use of computed tomography pulmonary angiography (CTPA)

• Published in: Emergency radiology Vol. 30; no. 1; pp. 63 - 69
• Main Authors: Salehi, Leila, Jaskolka, Jeff, Yu, Hubert, Ossip, Marc, Phalpher, Prashant, Valani, Rahim, Mercuri, Mathew
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01-02-2023; Springer Nature B.V
• Subjects: Angiography; Computed tomography; Computed Tomography Angiography - methods; Diagnostic systems; Emergency medical services; Emergency Medicine; Feedback; Humans; Imaging; Medical diagnosis; Medical imaging; Medicine; Medicine & Public Health; Ontario; Organizational aspects; Original; Original Article; Physicians; Prospective Studies; Pulmonary Embolism; Radiology; Tomography; Utilization; Ontario; Computed tomography angiography; Quality improvement; Diagnostic imaging; Medical overuse; Feedback; Physician Practice Patterns
• ISSN: 1438-1435; 1070-3004; 1438-1435
• DOI: 10.1007/s10140-022-02100-x

  
Purpose
The increased utilization, and potential overutilization, of computed tomography pulmonary angiography (CTPA) is a well-recognized issue within emergency departments (EDs). The objective of this study is to determine the impact of performance feedback reports on CTPA ordering behavior among ED physicians.
Methods
We conducted a prospective study of the impact of individualized performance feedback reports on the ordering behavior of physicians working at two high-volume community EDs in Ontario, Canada. We generated individualized reports (or “Dashboards”) for each ED physician containing detailed feedback and peer comparison for each physician’s CTPA ordering. Our baseline pre-intervention period was January 1 to December 31, 2018, and our intervention period was January 1, 2019, to December 31, 2021. We tracked individual and group ordering behavior through the study period. Our primary outcomes are impact of feedback on (1) overall group ordering rate and (2) overall diagnostic yield. Secondary analysis was done to determine the impact of the intervention on those physicians with the highest CTPA utilization rate.
Results
There was no statistically significant difference in the diagnostic yield of the included physicians in either of the years of the intervention period. There was a statically significant increase in the utilization rate for CTPA from 2018 to 2020 and 2021 from 5.9 to 7.9 and 11.4 CTPAs per 1000 ED visits respectively (
p
 < 0.5).
Conclusion
Our study found no consistent significant impact of individualized feedback and peer comparison on physician ordering of CTPAs. This points to a potentially greater impact of environmental and institutional factors, as opposed to physician-targeted quality improvement measures, on physician ordering behavior.