1. Medical Economics and Cost-Conscious Care Timothy Gong R3 Noon Conference September 6, 2012

2. Research Objective Identify an area of care within cardiac procedural interventions that can be changed to allow for cost-savings

3. Background Tools for workup of cardiac disease: – EKGs – Echocardiograms – Stress tests – Cardiac catheterization – Electrophysiology study – Cardiac MRI, PET, PET/CTA Cost covers procedure by tech or sonographer, interpretation by MD, procedure, and use of equipment 1 https://www.harvardpilgrim.org/portal/page?_pageid=253,192924&_dad=portal&_schema=PORTAL

4. Hypothesis Cardiac procedures, mostly echocardiograms, obtained at UCI within the month of February 2012 are repetitive

5. Study Population Age: neonatal to adult Sex: male and female Location: UCI Main Hospital Inclusion criteria: pts who have had multiple cardiac procedures within the month of February 2012 Exclusion criteria: pts who have had only one cardiac procedure within the month of February 2012

6. Methods Access obtained to Siemen’s SYNGO dynamics (electronic database) Quantify total # cardiac procedures performed during Feb 2012 Quantify total # pts with repeat tests performed during Feb 2012

7. Results Total # pts with cardiac procedures in February 2012: 617

8. Results Total # pts with cardiac procedures in February 2012: 617 Total # pts with multiple cardiac procedures in February 2012: 71

9. Results multiple ECHOs ECHO + Stress Test ECHO + TEE ECHO + Cath ECHO + EP Stress Test + Cath ECHO + TEE + Cath Total # pts 18 1025221

10. Discussion Are repeat ECHOs needed within 1 months’ time? If pt is at high risk and will need a stress test, are regular ECHOs needed prior? If pt has a clinical concern for vegetation, can we skip to TEE? If pt will need a cath, can we bypass the preliminary ECHO?

11. Summary ECHOs are often performed repeatedly on the same pts within the same month, prior to a stress ECHO, prior to TEE, and prior to cardiac catheterization likely adding to the cost of care. Minimizing the use of this routine test may substantially lower the cost of care at UCI.