• J Hosp Med · Dec 2017

    Observational Study

    Trends in Troponin-Only Testing for AMI in Academic Teaching Hospitals and the Impact of Choosing Wisely®.

    • Micah T Prochaska, Samuel F Hohmann, Matthew Modes, and Vineet M Arora.
    • Department of Medicine, The University of Chicago, Chicago, Illinois, USA. mprochas@medicine.bsd.uchicago.edu.
    • J Hosp Med. 2017 Dec 1; 12 (12): 957-962.

    BackgroundIdentifying 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 Wisely® campaign.ObjectiveTo examine the variation in cardiac biomarker testing and the effect of the Choosing Wisely® troponin-only recommendation for the diagnosis of AMI.DesignA retrospective observational study using administrative ordering data from Vizient's Clinical Database/Resource Manager.SettingNinety-one academic medical centers from the fourth quarter of 2013 through the third quarter of 2016.PatientsHospitalized patients with a principal discharge diagnosis of AMI.InterventionThe Choosing Wisely® recommendation to order troponin-only testing to diagnose AMI was released during the first quarter of 2015.ResultsIn 19 hospitals, troponin-only testing was consistently ordered to diagnose AMI before the Choosing Wisely® recommendation and throughout the study period. In 34 hospitals, both troponin and myoglobin/CK-MB were ordered to diagnose AMI even after the Choosing Wisely® recommendation. In 26 hospitals with low rates of troponin-only testing before the Choosing Wisely® recommendation, the release of the recommendation was associated with a statistically significant increase in the rate of troponin-only testing to diagnose AMI.ConclusionsIn institutions with low rates of troponin-only testing prior to the Choosing Wisely® recommendation, the recommendation was associated with a significant increase in the rate of troponin-only testing.© 2017 Society of Hospital Medicine

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