BACKGROUND Appropriate use criteria (AUC) have defined transthoracic echocardiogram (TTE) indications for which there is a clear lack of benefit as rarely appropriate (rA). OBJECTIVES This study sought to investigate the impact of an AUC-based educational intervention on outpatient TTE ordering by cardiologists and primary care providers. METHODS The authors conducted a prospective, investigator-blinded, multicenter, randomized controlled trial of an AUC-based educational intervention aimed at reducing rA outpatient TTEs. The study was conducted at 8 hospitals across 2 countries. The authors randomized cardiologists and primary care providers to receive either intervention or control (no intervention). The primary outcome measure was the proportion of rA TTEs. RESULTS One hundred and ninety-six physicians were randomized, and 179 were included in the analysis. From December 2014 to April 2016, the authors assessed 14,697 TTEs for appropriateness, of which 99% were classifiable using the 2011 AUC. The mean proportion of rA TTEs was significantly lower in the intervention versus the control group (8.8% vs. 10.1%; odds ratio [OR]: 0.75; 95% confidence interval [CI]: 0.57 to 0.99; p = 0.039). In physicians who ordered, on average, at least 1 TTE per month, there was a significantly lower proportion of rA TTEs in the intervention versus the control group (8.6% vs. 11.1%; OR: 0.76; 95% CI: 0.57 to 0.99; p = 0.047). There was no difference in the TTE ordering volume between the intervention and control groups (mean 77.7 ± 89.3 vs. 85.4 ± 111.4; p = 0.83). CONCLUSIONS An educational intervention reduced the number of rA TTEs ordered by attending physicians in a variety of ambulatory care environments. This may prove to be an effective strategy to improve the use of imaging. (A Multi-Centered Feedback and Education Intervention Designed to Reduce Inappropriate Transthoracic Echocardiograms [Echo WISELY]; NCT02038101).

中文翻译：

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改善经胸超声心动图的适当使用

背景 适当的使用标准 (AUC) 已经定义了经胸超声心动图 (TTE) 的适应症，这些适应症明显缺乏益处，很少适用 (rA)。目的 本研究旨在调查基于 AUC 的教育干预对心脏病专家和初级保健提供者门诊 TTE 订购的影响。方法 作者对一项旨在减少 rA 门诊 TTE 的基于 AUC 的教育干预进行了前瞻性、研究者设盲、多中心、随机对照试验。该研究在 2 个国家的 8 家医院进行。作者将心脏病专家和初级保健提供者随机分配接受干预或对照（无干预）。主要结局指标是 rA TTE 的比例。结果 196 名医生被随机分组​​，179 个被纳入分析。从 2014 年 12 月到 2016 年 4 月，作者评估了 14,697 个 TTE 的适当性，其中 99% 可以使用 2011 AUC 进行分类。与对照组相比，干预组中 rA TTE 的平均比例显着降低（8.8% 与 10.1%；优势比 [OR]：0.75；95% 置信区间 [CI]：0.57 至 0.99；p = 0.039）。在平均每月至少订购 1 次 TTE 的医生中，干预组中 rA TTE 的比例显着低于对照组（8.6% 对 11.1%；OR：0.76；95% CI：0.57 至 0.99 ; p = 0.047)。干预组和对照组之间的 TTE 订购量没有差异（平均 77.7 ± 89.3 与 85.4 ± 111.4；p = 0.83）。结论 教育干预减少了主治医师在各种门诊护理环境中订购的 rA TTE 数量。这可能被证明是改善成像使用的有效策略。（旨在减少不当经胸超声心动图 [Echo WISELY] 的多中心反馈和教育干预；NCT02038101）。