National data suggests that ~10% of echocardiograms may be unnecessary, which prompted clinical leadership to inquire about Michigan Medicine’s own echo use. After evaluating the data, MPrOVE concluded that Michigan Medicine is on par with other peer institutions for echo use and any efforts to reduce low-value echo would not yield remarkable improvements in care or resources.

Background: Inpatient surface echocardiograms ordered for patients on medical services were identified as tests that may be overused within Michigan Medicine, particularly repeat echos. National data suggests that ~10% of echocardiograms may be unnecessary.

Understanding if a potential Quality problem is worth intervening on in the first place is a critical step to help allocate unit resources and prioritize quality improvement work across the organization. The methods used here demonstrate the utility of an opportunity estimate approach in QI via a demonstration project on repeat echo use.

MPrOVE Role: Vizient data was used to compare Michigan Medicine echo utilization by service line to the median value of the corresponding service lines from other hospitals on the US News Top 20 2018 Honor Roll.  Measurement of repeat echos evaluated frequency of repeat echo use within the same admission, within 3 months prior to admission, and within 12 months prior to admission.

Outcomes: While it was found that echo volume and the rate of echos did increase during 2017-2019, there were other factors that contributed to this increase (a higher volume of cardiac surgeries completed) and Michigan Medicine was on par with other peer institutions. Additionally, there was no clear volume patterns or service lines that had particularly high amounts of repeat echos.

From this Opportunity Estimate, MPrOVE was able to determine that the hypothesis that over-utilization of echocardiograms was not worth intervening on, a critical step to help allocate unit resources and prioritize quality improvement work across the organization.