Can physicians identify inappropriate nuclear stress tests? An examination of inter-rater reliability for the 2009 appropriate use criteria for radionuclide imaging
We sought to determine inter-rater reliability of the 2009 Appropriate Use Criteria for radionuclide imaging and whether physicians at various levels of training can effectively identify nuclear stress tests with inappropriate indications. Four hundred patients were randomly selected from a consecut...
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Published in | Circulation Cardiovascular quality and outcomes Vol. 8; no. 1; pp. 23 - 29 |
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Main Authors | , , , , , , , , , , |
Format | Journal Article |
Language | English |
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01.01.2015
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Abstract | We sought to determine inter-rater reliability of the 2009 Appropriate Use Criteria for radionuclide imaging and whether physicians at various levels of training can effectively identify nuclear stress tests with inappropriate indications.
Four hundred patients were randomly selected from a consecutive cohort of patients undergoing nuclear stress testing at an academic medical center. Raters with different levels of training (including cardiology attending physicians, cardiology fellows, internal medicine hospitalists, and internal medicine interns) classified individual nuclear stress tests using the 2009 Appropriate Use Criteria. Consensus classification by 2 cardiologists was considered the operational gold standard, and sensitivity and specificity of individual raters for identifying inappropriate tests were calculated. Inter-rater reliability of the Appropriate Use Criteria was assessed using Cohen κ statistics for pairs of different raters. The mean age of patients was 61.5 years; 214 (54%) were female. The cardiologists rated 256 (64%) of 400 nuclear stress tests as appropriate, 68 (18%) as uncertain, 55 (14%) as inappropriate; 21 (5%) tests were unable to be classified. Inter-rater reliability for noncardiologist raters was modest (unweighted Cohen κ, 0.51, 95% confidence interval, 0.45-0.55). Sensitivity of individual raters for identifying inappropriate tests ranged from 47% to 82%, while specificity ranged from 85% to 97%.
Inter-rater reliability for the 2009 Appropriate Use Criteria for radionuclide imaging is modest, and there is considerable variation in the ability of raters at different levels of training to identify inappropriate tests. |
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AbstractList | BACKGROUNDWe sought to determine inter-rater reliability of the 2009 Appropriate Use Criteria for radionuclide imaging and whether physicians at various levels of training can effectively identify nuclear stress tests with inappropriate indications.METHODS AND RESULTSFour hundred patients were randomly selected from a consecutive cohort of patients undergoing nuclear stress testing at an academic medical center. Raters with different levels of training (including cardiology attending physicians, cardiology fellows, internal medicine hospitalists, and internal medicine interns) classified individual nuclear stress tests using the 2009 Appropriate Use Criteria. Consensus classification by 2 cardiologists was considered the operational gold standard, and sensitivity and specificity of individual raters for identifying inappropriate tests were calculated. Inter-rater reliability of the Appropriate Use Criteria was assessed using Cohen κ statistics for pairs of different raters. The mean age of patients was 61.5 years; 214 (54%) were female. The cardiologists rated 256 (64%) of 400 nuclear stress tests as appropriate, 68 (18%) as uncertain, 55 (14%) as inappropriate; 21 (5%) tests were unable to be classified. Inter-rater reliability for noncardiologist raters was modest (unweighted Cohen κ, 0.51, 95% confidence interval, 0.45-0.55). Sensitivity of individual raters for identifying inappropriate tests ranged from 47% to 82%, while specificity ranged from 85% to 97%.CONCLUSIONSInter-rater reliability for the 2009 Appropriate Use Criteria for radionuclide imaging is modest, and there is considerable variation in the ability of raters at different levels of training to identify inappropriate tests. Background— We sought to determine inter-rater reliability of the 2009 Appropriate Use Criteria for radionuclide imaging and whether physicians at various levels of training can effectively identify nuclear stress tests with inappropriate indications. Methods and Results— Four hundred patients were randomly selected from a consecutive cohort of patients undergoing nuclear stress testing at an academic medical center. Raters with different levels of training (including cardiology attending physicians, cardiology fellows, internal medicine hospitalists, and internal medicine interns) classified individual nuclear stress tests using the 2009 Appropriate Use Criteria. Consensus classification by 2 cardiologists was considered the operational gold standard, and sensitivity and specificity of individual raters for identifying inappropriate tests were calculated. Inter-rater reliability of the Appropriate Use Criteria was assessed using Cohen κ statistics for pairs of different raters. The mean age of patients was 61.5 years; 214 (54%) were female. The cardiologists rated 256 (64%) of 400 nuclear stress tests as appropriate, 68 (18%) as uncertain, 55 (14%) as inappropriate; 21 (5%) tests were unable to be classified. Inter-rater reliability for noncardiologist raters was modest (unweighted Cohen κ, 0.51, 95% confidence interval, 0.45–0.55). Sensitivity of individual raters for identifying inappropriate tests ranged from 47% to 82%, while specificity ranged from 85% to 97%. Conclusions— Inter-rater reliability for the 2009 Appropriate Use Criteria for radionuclide imaging is modest, and there is considerable variation in the ability of raters at different levels of training to identify inappropriate tests. We sought to determine inter-rater reliability of the 2009 Appropriate Use Criteria for radionuclide imaging and whether physicians at various levels of training can effectively identify nuclear stress tests with inappropriate indications. Four hundred patients were randomly selected from a consecutive cohort of patients undergoing nuclear stress testing at an academic medical center. Raters with different levels of training (including cardiology attending physicians, cardiology fellows, internal medicine hospitalists, and internal medicine interns) classified individual nuclear stress tests using the 2009 Appropriate Use Criteria. Consensus classification by 2 cardiologists was considered the operational gold standard, and sensitivity and specificity of individual raters for identifying inappropriate tests were calculated. Inter-rater reliability of the Appropriate Use Criteria was assessed using Cohen κ statistics for pairs of different raters. The mean age of patients was 61.5 years; 214 (54%) were female. The cardiologists rated 256 (64%) of 400 nuclear stress tests as appropriate, 68 (18%) as uncertain, 55 (14%) as inappropriate; 21 (5%) tests were unable to be classified. Inter-rater reliability for noncardiologist raters was modest (unweighted Cohen κ, 0.51, 95% confidence interval, 0.45-0.55). Sensitivity of individual raters for identifying inappropriate tests ranged from 47% to 82%, while specificity ranged from 85% to 97%. Inter-rater reliability for the 2009 Appropriate Use Criteria for radionuclide imaging is modest, and there is considerable variation in the ability of raters at different levels of training to identify inappropriate tests. |
Author | Paz, Yehuda Ye, Siqin Kelly, Christopher R Rabbani, LeRoy E Lewis, Matthew Bokhari, Sabahat Weiner, Shepard D Rao, Shaline Einstein, Andrew J Kelly, Maureen R Peck, Clara L |
AuthorAffiliation | 1 Department of Medicine, Columbia University Medical Center and New York-Presbyterian Hospital, New York, New York |
AuthorAffiliation_xml | – name: 1 Department of Medicine, Columbia University Medical Center and New York-Presbyterian Hospital, New York, New York |
Author_xml | – sequence: 1 givenname: Siqin surname: Ye fullname: Ye, Siqin email: sy2357@cumc.columbia.edu organization: From the Department of Medicine, Columbia University Medical Center and New York-Presbyterian Hospital. sy2357@cumc.columbia.edu – sequence: 2 givenname: LeRoy E surname: Rabbani fullname: Rabbani, LeRoy E organization: From the Department of Medicine, Columbia University Medical Center and New York-Presbyterian Hospital – sequence: 3 givenname: Christopher R surname: Kelly fullname: Kelly, Christopher R organization: From the Department of Medicine, Columbia University Medical Center and New York-Presbyterian Hospital – sequence: 4 givenname: Maureen R surname: Kelly fullname: Kelly, Maureen R organization: From the Department of Medicine, Columbia University Medical Center and New York-Presbyterian Hospital – sequence: 5 givenname: Matthew surname: Lewis fullname: Lewis, Matthew organization: From the Department of Medicine, Columbia University Medical Center and New York-Presbyterian Hospital – sequence: 6 givenname: Yehuda surname: Paz fullname: Paz, Yehuda organization: From the Department of Medicine, Columbia University Medical Center and New York-Presbyterian Hospital – sequence: 7 givenname: Clara L surname: Peck fullname: Peck, Clara L organization: From the Department of Medicine, Columbia University Medical Center and New York-Presbyterian Hospital – sequence: 8 givenname: Shaline surname: Rao fullname: Rao, Shaline organization: From the Department of Medicine, Columbia University Medical Center and New York-Presbyterian Hospital – sequence: 9 givenname: Sabahat surname: Bokhari fullname: Bokhari, Sabahat organization: From the Department of Medicine, Columbia University Medical Center and New York-Presbyterian Hospital – sequence: 10 givenname: Shepard D surname: Weiner fullname: Weiner, Shepard D organization: From the Department of Medicine, Columbia University Medical Center and New York-Presbyterian Hospital – sequence: 11 givenname: Andrew J surname: Einstein fullname: Einstein, Andrew J organization: From the Department of Medicine, Columbia University Medical Center and New York-Presbyterian Hospital |
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Cites_doi | 10.1001/jama.2010.1664 10.1016/j.ahj.2009.12.004 10.1161/CIRCULATIONAHA.113.002744 10.1177/1536867X0400400404 10.1056/NEJMoa0901249 10.1016/j.jacc.2013.04.059 10.1016/j.jacc.2013.01.025 10.1016/j.jacc.2007.10.064 10.1093/oxfordjournals.aje.a116813 10.1016/j.jacc.2009.11.004 10.1007/s12350-011-9467-8 10.1161/CIRCULATIONAHA.110.975995 10.1016/j.jacc.2005.08.029 10.1016/j.jacc.2012.11.056 10.1161/CIRCULATIONAHA.105.560433 10.1016/j.nuclcard.2007.10.010 10.1056/NEJM199806253382607 10.1016/j.jcmg.2013.01.012 10.1016/j.amjmed.2005.09.052 10.1007/s12350-011-9368-x 10.1016/j.jac 10.1161/circulationaha.107.185699 10.1016/j.amjcard.2012.03.026 10.1007/s12350-011-9459-8 10.1097/00001888-200308000-00003 10.1016/j.jacc.2010.10.050 10.1056/NEJMhpr061219 10.1056/NEJM197906143002402 |
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Snippet | We sought to determine inter-rater reliability of the 2009 Appropriate Use Criteria for radionuclide imaging and whether physicians at various levels of... Background— We sought to determine inter-rater reliability of the 2009 Appropriate Use Criteria for radionuclide imaging and whether physicians at various... BACKGROUNDWe sought to determine inter-rater reliability of the 2009 Appropriate Use Criteria for radionuclide imaging and whether physicians at various levels... |
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SubjectTerms | Academic Medical Centers Adult Aged Electronic Health Records Female Guideline Adherence - standards Humans Male Middle Aged New York City Observer Variation Patient Selection Practice Guidelines as Topic - standards Practice Patterns, Physicians' - standards Predictive Value of Tests Quality Indicators, Health Care - standards Radionuclide Imaging - standards Radionuclide Imaging - statistics & numerical data Retrospective Studies Risk Factors Unnecessary Procedures - statistics & numerical data |
Title | Can physicians identify inappropriate nuclear stress tests? An examination of inter-rater reliability for the 2009 appropriate use criteria for radionuclide imaging |
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