Effect of Targeted Interventions to Improve Value Based Health Care for Inpatient Cardiology Patients

The cost of healthcare in the United States has risen precipitously over the last forty
years. In 2014, healthcare spending surpassed $3 trillion and accounted for 17.5 percent of
the national gross domestic product. The Institute of Medicine's report "Best Care at Lower
Cost" estimated that 30 percent, or approximately $900 billion in 2014, of healthcare
expenditures are wasted. Given this wasted spending, great urgency has been placed on curbing
the ever-increasing cost of healthcare while simultaneously improving quality and patient
safety. Despite improvements in mortality associated with cardiovascular disease over the
last two decades, the cost of cardiovascular care continues to rise and is estimated to be in
excess of $186 billion by 2023. A number of studies have been performed evaluating the
cost-effectiveness and appropriate use of routine transthoracic echocardiography;
nonetheless, there is little evidence that the results of these studies have been translated
into clinical practice. In order to close the gap between the literature and clinical
practice, we plan to initiate a combined didactic and data feedback program that will present
the current literature and in-hospital charges associated with echocardiography to practicing
clinicians on inpatient cardiology services. We will measure the effect of our intervention
on average per-patient in-hospital charges as well as usage rates and other clinical
outcomes.

Research Design and Methods: The investigators will perform a prospective, controlled cohort
study period comparing the effect of a combined didactic and data feedback intervention on
in-hospital charges, usage rates, and clinical outcomes to providers. The investigator's
intervention will consist of a biweekly email to three house staff-run cardiology services at
VUMC presenting the in-hospital charges and appropriate use of echocardiography per ACC/AHA
guidlines. A weekly email will also be sent to the intervention services detailing their
team's in-hospital charges for echocardiograms during the preceding week. Usage and
in-hospital charges will be measured using a custom tableau which captures all orders placed
in the HeoWiz ordering program and the raw master charges. The investigators will utilize a
pre and post intervention design to study primary and secondary outcomes. The primary outcome
will be average echocardiography charges per team. The secondary outcomes will be
echocardiograms performed per team per month, and number of focused echocardiograms performed
per team per month. Quality of care will be assessed by monitoring 30 day readmission rate,
and index hospitalization mortality.

Inclusion Criteria:

- All residents rotation through inpatient cardiology teams at a large academic medical
center

Exclusion Criteria:

- Residents who elect to not recieve feedback email