Promoting Judicious Primary Care Referral of Patients with Chest Pain to Cardiology: A Quality Improvement Initiative

Ashraf S. Harahsheh, Ellen K. Hamburger, Lena Saleh, Lexi M. Crawford, Edward Sepe, Ariel Dubelman, Lena Baram, Kathleen M. Kadow, Christina Driskill, Kathy Prestidge, James E. Bost and Deena Berkowitz
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Ashraf S. Harahsheh: Department of Pediatrics, George Washington University School of Medicine & Health Sciences, Washington, DC, USA
Ellen K. Hamburger: Department of Pediatrics, George Washington University School of Medicine & Health Sciences, Washington, DC, USA
Lena Saleh: Children’s National Hospital, Washington, DC, USA
Lexi M. Crawford: Children’s National Hospital, Washington, DC, USA
Edward Sepe: Department of Pediatrics, George Washington University School of Medicine & Health Sciences, Washington, DC, USA
Ariel Dubelman: Children’s National Pediatricians & Associates, Washington, DC, USA
Lena Baram: Department of Pediatrics, George Washington University School of Medicine & Health Sciences, Washington, DC, USA
Kathleen M. Kadow: Children’s National Pediatricians & Associates, Washington, DC, USA
Christina Driskill: Children’s National Pediatricians & Associates, Washington, DC, USA
Kathy Prestidge: Children’s National Pediatricians & Associates, Washington, DC, USA
James E. Bost: Department of Pediatrics, George Washington University School of Medicine & Health Sciences, Washington, DC, USA
Deena Berkowitz: Department of Pediatrics, George Washington University School of Medicine & Health Sciences, Washington, DC, USA

Medical Decision Making, 2021, vol. 41, issue 5, 559-572

Abstract: Objective To decrease referrals to cardiology of patients ages 7 to 21 years with low-probability cardiac pathology who presented to primary care with chest pain by 50% within 24 months. Study Design A multidisciplinary team designed and implemented an initiative consisting of 1) a decision support tool (DST), 2) educational sessions, 3) routine feedback to improve use of referral criteria, and 4) patient family education. Four pediatric practices, comprising 34 pediatricians and 7 nurse practitioners, were included in this study. We tracked progress via statistical process control charts. Results A total of 421 patients ages 7 to 21 years presented with chest pain to their pediatrician. The utilization of the DST increased from baseline of 16% to 68%. Concurrently, the percentage of low-probability cardiology referrals in pediatric patients ages 7 to 21 years who presented with chest pain decreased from 17% to 5% after our interventions. At a median follow-up time of 0.9 years (interquartile range, 0.3–1.6 years), no patient had a life-threatening cardiac event. Conclusion Our health care improvement initiative to reduce low-probability cardiology referrals for children presenting to primary care practices with chest pain was feasible, effective, and safe.

Keywords: pediatric cardiology; overreferrals; subspecialty consultation; ambulatory care; primary care; health care resource utilization (search for similar items in EconPapers)
Date: 2021
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Persistent link: https://EconPapers.repec.org/RePEc:sae:medema:v:41:y:2021:i:5:p:559-572

DOI: 10.1177/0272989X21991445

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