Effects of Process Improvement on Guideline-Concordant Cardiac Enzyme Testing
Easily implemented ordering practices in the electronic health record increased the rate of guideline-concordant testing, decreased cost, and furthered the goal of high-value medical care.
Gregory Condos is a Cardiology Fellow at Naval Medical Center San Diego in California. Yohannes Tesema is a Statistician at the Veterans Health Administration in Denver, Colorado. Megha Joshi is a Nephrologist at Walter Reed National Military Medical Center in Bethesda, Maryland. Andrew Lin is a Cardiologist at the Naval Medical Center Portsmouth in Virginia. Paul Rockswold is Director of Epidemiology and Public Health at Cogency Medical in Baltimore, Maryland. Gregory Condos and Megha Joshi are Assistant Professors, Andrew Lin is an Associate Professor, and Paul Rockswold is an Adjunct Associate Professor, all at the Uniformed Services University of the Health Sciences in Bethesda. Correspondence: Greg Condos (greg.condos@gmail.com)
Author disclosures The authors report no actual or potential conflicts of interest with regard to this article.
Disclaimer The opinions expressed herein are those of the authors and do not necessarily reflect those of Federal Practitioner, Frontline Medical Communications Inc., the US Government, or any of its agencies.
This study was not designed to answer the source of variation from guidelines. Many patients had only 1 test, which we feel represents an opportunity for future study to identify other ways cardiac enzyme testing is being used clinically. These tests might be used for patients without convincing symptoms and signs of coronary syndromes or for patients with other primary problems. Third, by using the ITS analysis, we assumed that the outcome during each intervention period follows a linear pattern. However, changes may follow a nonlinear pattern over a long period. Finally, our intervention was limited to only a single MTF, which may limit generalizability to other facilities across military medicine. However, we feel this study should serve as a guide for other MTFs as well as US Department of Veterans Affairs facilities that could institute similar process improvements.
Conclusion
We made easily implemented and durable process improvement interventions that changed institution-wide ordering practices. These changes dramatically increased the rate of guideline-concordant testing, decreasing cost and furthering the goal of high-value medical care.
