Identifying hospitals that are both early and consistent adopters of high-value care can help shed light on the culture and practices at those institutions that are necessary to promote high-value care nationwide. The use of troponin to diagnose acute myocardial infarction (AMI), and not to test for myoglobin or creatine kinase-MB (CK-MB), is a high-value recommendation of the Choosing Wisely® campaign.OBJECTIVE:
To examine the variation in cardiac biomarker testing and the effect of the Choosing Wisely® troponin-only recommendation for the diagnosis of AMI.DESIGN:
A retrospective observational study using administrative ordering data from Vizient's Clinical Database/Resource Manager.SETTING:
Ninety-one academic medical centers from the fourth quarter of 2013 through the third quarter of 2016.PATIENTS:
Hospitalized patients with a principal discharge diagnosis of AMI.INTERVENTION:
The Choosing Wisely® recommendation to order troponin-only testing to diagnose AMI was released during the first quarter of 2015.RESULTS:
In 19 hospitals, troponin-only testing was consistently ordered to diagnose AMI before the Choosing Wisely® recommendation and throughout the study period. In 34 hospitals, both troponin and myoglobin/CK-MB were ordered to diagnose AMI even after the Choosing Wisely® recommendation. In 26 hospitals with low rates of troponin-only testing before the Choosing Wisely® recommendation, the release of the recommendation was associated with a statistically significant increase in the rate of troponin-only testing to diagnose AMI.CONCLUSION:
In institutions with low rates of troponin-only testing prior to the Choosing Wisely® recommendation, the recommendation was associated with a significant increase in the rate of troponin-only testing.