| Effect of patient-specific ratings vs conventional guidelines on investigation decisions in angina: Appropriateness of Referral and Investigation in Angina (ARIA) Trial. | |
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MedLine Citation:
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PMID: 17242322 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Conventional guidelines have limited effect on changing physicians' test ordering. We sought to determine the effect of patient-specific ratings vs conventional guidelines on appropriate investigation of angina. METHODS: Randomized controlled trial of 145 physicians receiving patient-specific ratings (online prompt stating whether the specific vignette was considered appropriate or inappropriate for investigation, with access to detailed information on how the ratings were derived) and 147 physicians receiving conventional guidelines from the American Heart Association and the European Society of Cardiology. Physicians made recommendations on 12 Web-based patient vignettes before and on 12 vignettes after these interventions. The outcome was the proportion of appropriate investigative decisions as defined by 2 independent expert panels. RESULTS: Decisions for exercise electrocardiography were more appropriate with patient-specific ratings (819/1491 [55%]) compared with conventional guidelines (648/1488 [44%]) (odds ratio [OR], 1.57; 95% confidence interval [CI], 1.36-1.82). The effect was stronger for angiography (1274/1595 [80%] with patient-specific ratings compared with 1009/1576 [64%] with conventional guidelines [OR, 2.24; 95% CI, 1.90-2.62]). Within-arm comparisons confirmed that conventional guidelines had no effect but that patient-specific ratings significantly changed physicians' decisions toward appropriate recommendations for exercise electrocardiography (55% vs 42%; OR, 2.62; 95% CI, 2.14-3.22) and for angiography (80% vs 65%; OR, 2.10; 95% CI, 1.79-2.47). These effects were robust to physician specialty (cardiologists and general practitioners) and to vignette characteristics, including older age, female sex, and nonwhite race/ethnicity. CONCLUSION: Patient-specific ratings, unlike conventional guidelines, changed physician testing behavior and have the potential to reduce practice variations and to increase the appropriate use of investigation. |
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Authors:
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Cornelia Junghans; Gene Feder; Adam D Timmis; Sandra Eldridge; Neha Sekhri; Nick Black; Paul Shekelle; Harry Hemingway |
Publication Detail:
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Type: Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Archives of internal medicine Volume: 167 ISSN: 0003-9926 ISO Abbreviation: Arch. Intern. Med. Publication Date: 2007 Jan |
Date Detail:
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Created Date: 2007-01-23 Completed Date: 2007-02-16 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0372440 Medline TA: Arch Intern Med Country: United States |
Other Details:
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Languages: eng Pagination: 195-202 Citation Subset: AIM; IM |
Affiliation:
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Department of Epidemiology and Public Health, University College London Medical School, England. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Aged, 80 and over Angina Pectoris / diagnosis* Angiography / utilization* Cardiology Decision Making Electrocardiography / utilization* Exercise Test / utilization* Female Humans Logistic Models Male Middle Aged Outcome Assessment (Health Care) Physician's Practice Patterns / statistics & numerical data* Physicians, Family Practice Guidelines as Topic |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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