Australian echo registry data: a study in quality improvement

A national data registry for echocardiography set up in 2009 has helped improve consistency of care and patient outcomes by improving the completeness, accuracy and clinical value of echocardiographic data in Australia, a new review says.

An analysis of over 4 million echocardiograph studies captured in the GenesisCare Cardiovascular Outcomes Echo Registry (GCOR-Echo) across 63 sites between January 2010 and December 2021 found 36% of the studies were de novo rather than follow-up or progress studies.

The research, published in openheart, said the proportion of de novo studies was significantly higher than in international series.

“The lower proportion of repeat studies in the GCOR series may have been due to a combination of more conservative local practice patterns, societal recommendations and guidelines for reimbursement from public and private payors,” it said.

It said data completeness improved significantly over time with a centralised quality improvement process.

“Completeness of reporting of LVEF by formal calculation rather than just visual estimation rose significantly from 2010 to 2014 (63.92%±34.89% vs 90.92%±5.18%, p<0.0001). Completeness of ejection fraction (EF) reporting improved further from 2014 to 2020 (91.93%±5.18% vs 92.8%±4.08%, p=0.0001).”

Similarly, completeness of reporting of E/e’ similarly rose significantly from 2010 to 2014 (55.27% to 78.74%) and again from 2014 to 2020 (78.74% to 82.28%).

The improvements, such as documentation of a measured LVEF included on at least 90% of transthoracic echocardiogram reports, bring practice in line with guidelines.

The authors said interpractice variability also fell significantly over the study period.

“This improved rapidly and globally across the entire network once centralised reporting of data and feedback to local centres through a centralised quality improvement process were implemented in Australian private hospitals and outpatient clinics.”

“Introduction of local quality initiatives via a unified national data set and database over a 2-year period significantly improved reporting of key quality echo measures.”

It said the GCOR-Echo Registry allowed benchmarking treatment against international guidelines and practice and was an example of how developing national clinical cardiology registries may enable clinicians’ efforts to improve patient care.

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