Educational Initiatives for Quality Improvement Projects

Noninvasive imaging has become a cornerstone of the practice of cardiovascular medicine. When properly applied, the information obtained from cardiac imaging studies, integrated with overall clinical assessment, can be used to diagnose disease, determine its functional and physiological impact, assess prognosis, and guide therapeutic decisions. The last 2 decades have seen enormous growth in all medical imaging procedures.1 A major component of this increased utilization was in stress nuclear myocardial perfusion imaging (MPI) single-photon emission-computed tomography (SPECT), which has become one of the most commonly used and effective methods to assess patients with known or suspected coronary artery disease. The reasons for this growth have been, and will continue to be, debated for some time. On the more “positive” side, this growth may have been stimulated by a substantial body of research demonstrating the utility of MPI in a wide variety of clinical scenarios. Moreover, advancements in imaging technology and improved access to care may have been contributory. On the “negative” side, some argue that the growth in imaging has been fueled by misguided financial incentives and the practice of “defensive” medicine. One fact, however, is indisputable: Imaging accounts for a large amount of overall healthcare expenditures, and despite the potential for imaging to reduce downstream costs, control of this escalating cost has become central to public healthcare policy. Accordingly, constraint of this growth of cardiac imaging has become a major effort of the government, medical insurers, and professional societies. What is the best method for controlling the proliferation of cardiac imaging, and how should these methods be used to effect change in physician behavior?Article see p 499In this issue of Circulation , Gibbons and colleagues2 report on their experience in the implementation of one such methodology, the appropriate use criteria (AUC) for SPECT MPI, in …