Feedback for doctors leads to reduced patient testing

TORONTO – Doctors ordered fewer unnecessary cardiology tests when they watched an educational video and received monthly feedback reports, according to a new randomized study in Ontario and the United States.

Echocardiograms are ultrasounds of the heart and one of the most commonly ordered diagnostic tests. They allow doctors to watch the organ beat, check if a valve is leaking or look for damage after a heart attack. But they can also lead to false positive findings that can snowball into more invasive tests, and potentially, harm to patients.

CBC News reports that Dr. Sacha Bhatia (pictured), a cardiologist at Women’s College Hospital and Toronto’s University Hospital Network and his team have tested a way to reduce unnecessary echocardiograms, at least in the short term.

In the Journal of the American College of Cardiology, Dr. Bhatia and his co-authors reported the results of a trial, called Echo Wisely, that randomly assigned 196 physicians in Toronto, Kingston, Ont., and Boston to receive an educational video along with individualized, monthly feedback from an app. They were compared with a group that did not receive the video and app.

Cardiologists and primary care providers who received the support had a lower rate of unnecessary testing (8.6 per cent) compared with those who did not (11.1 per cent), Bhatia and his team said.

“Often times, because our technology has gotten better and better, we tend to see things that may or may not be useful to the patient,” Dr. Bhatia said.

Bhatia said he didn’t realize the extent to which the feedback would make a difference and got him thinking about how physicians rarely receive any. “[Telling] people how they’re doing can help drive improvements in performance even when it’s not tied to any incentives.”

Dr. Bhatia called the individual feedback and anonymous findings of doctors’ peers a powerful tool in changing behaviour.

While physicians often strived for high grades and are often motivated to improve their performance, Bhatia acknowledged that once feedback stops, a U.S. study suggests they revert back.

Since the study participants were mainly from teaching hospitals, Bhatia expects the findings would apply elsewhere in Canada. It’s not clear if it would generalize to doctors working at community hospitals or in private offices where many of these tests are done. The long-term sustainability also needs to be studied.

Overall, it is estimated that up to 30 percent of diagnostic tests – of all kinds – are unnecessarily ordered each year in Canada. Groups such as the Canadian Institute for Health Information and Choosing Wisely Canada are trying to reduce unnecessary testing, which raise healthcare costs and in some cases endanger patient safety.