{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T06:09:46Z","timestamp":1760249386088,"version":"3.41.2"},"reference-count":22,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"8","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Imaging"],"published-print":{"date-parts":[[2017,8]]},"abstract":"<jats:sec>\n            <jats:title>Background\u2014<\/jats:title>\n            <jats:p>Clinical outcomes after surgical treatment of mitral regurgitation are worse if intervention occurs after deterioration of left ventricular size and function. Transthoracic echocardiographic (TTE) surveillance of patients with mitral regurgitation is indicated to avoid adverse ventricular remodeling. Overly frequent TTEs can impair patient access and reduce value in care delivery. This balance between timely surveillance and overutilization of TTE in valvular disease provides a model to study variation in the delivery of healthcare services. We investigated patient and provider factors contributing to variation in TTE utilization and hypothesized that variation was attributable to provider practice even after adjustment for patient characteristics.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods and Results\u2014<\/jats:title>\n            <jats:p>We obtained records of all TTEs from 2001 to 2016 completed at a large echocardiography laboratory. The outcome variable was time interval between TTEs. We constructed a mixed-effects linear regression model with the individual physician as the random effect in the model and used intraclass correlation coefficient to assess the proportion of outcome variation because of provider practice. Our study cohort was 55\u2009773 TTEs corresponding to 37\u2009843 intervals ordered by 635 providers. The mean interval between TTEs was 12.4 months, 17.0 months, 18.3 months, and 17.4 months for severe, moderate, mild, and trace mitral regurgitation, respectively, with 20% of providers deemed overutilizers of TTEs and 25% underutilizers.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions\u2014<\/jats:title>\n            <jats:p>We conclude that there is substantial variation in follow-up intervals for TTE assessment of mitral regurgitation, despite risk-adjustment for patient variables, likely because of provider factors.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circimaging.117.006495","type":"journal-article","created":{"date-parts":[[2017,8,4]],"date-time":"2017-08-04T00:50:27Z","timestamp":1501807827000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":8,"title":["Variation in the Echocardiographic Surveillance of Primary Mitral Regurgitation"],"prefix":"10.1161","volume":"10","author":[{"given":"Varsha K.","family":"Tanguturi","sequence":"first","affiliation":[{"name":"From the Division of Cardiology (V.K.T., M.H.P., J.H.W.), Department of Medicine (V.K.T., M.H.P., J.H.W., S.J.A., K.A.), Massachusetts General Hospital, Harvard Medical School, Boston; and Massachusetts General Physicians Organization, Boston (M.K.H., M.H.P., S.J.A., J.B.W., T.G.F., J.H.W.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael K.","family":"Hidrue","sequence":"additional","affiliation":[{"name":"From the Division of Cardiology (V.K.T., M.H.P., J.H.W.), Department of Medicine (V.K.T., M.H.P., J.H.W., S.J.A., K.A.), Massachusetts General Hospital, Harvard Medical School, Boston; and Massachusetts General Physicians Organization, Boston (M.K.H., M.H.P., S.J.A., J.B.W., T.G.F., J.H.W.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael H.","family":"Picard","sequence":"additional","affiliation":[{"name":"From the Division of Cardiology (V.K.T., M.H.P., J.H.W.), Department of Medicine (V.K.T., M.H.P., J.H.W., S.J.A., K.A.), Massachusetts General Hospital, Harvard Medical School, Boston; and Massachusetts General Physicians Organization, Boston (M.K.H., M.H.P., S.J.A., J.B.W., T.G.F., J.H.W.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Steven J.","family":"Atlas","sequence":"additional","affiliation":[{"name":"From the Division of Cardiology (V.K.T., M.H.P., J.H.W.), Department of Medicine (V.K.T., M.H.P., J.H.W., S.J.A., K.A.), Massachusetts General Hospital, Harvard Medical School, Boston; and Massachusetts General Physicians Organization, Boston (M.K.H., M.H.P., S.J.A., J.B.W., T.G.F., J.H.W.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeffrey B.","family":"Weilburg","sequence":"additional","affiliation":[{"name":"From the Division of Cardiology (V.K.T., M.H.P., J.H.W.), Department of Medicine (V.K.T., M.H.P., J.H.W., S.J.A., K.A.), Massachusetts General Hospital, Harvard Medical School, Boston; and Massachusetts General Physicians Organization, Boston (M.K.H., M.H.P., S.J.A., J.B.W., T.G.F., J.H.W.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Timothy G.","family":"Ferris","sequence":"additional","affiliation":[{"name":"From the Division of Cardiology (V.K.T., M.H.P., J.H.W.), Department of Medicine (V.K.T., M.H.P., J.H.W., S.J.A., K.A.), Massachusetts General Hospital, Harvard Medical School, Boston; and Massachusetts General Physicians Organization, Boston (M.K.H., M.H.P., S.J.A., J.B.W., T.G.F., J.H.W.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katrina","family":"Armstrong","sequence":"additional","affiliation":[{"name":"From the Division of Cardiology (V.K.T., M.H.P., J.H.W.), Department of Medicine (V.K.T., M.H.P., J.H.W., S.J.A., K.A.), Massachusetts General Hospital, Harvard Medical School, Boston; and Massachusetts General Physicians Organization, Boston (M.K.H., M.H.P., S.J.A., J.B.W., T.G.F., J.H.W.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jason H.","family":"Wasfy","sequence":"additional","affiliation":[{"name":"From the Division of Cardiology (V.K.T., M.H.P., J.H.W.), Department of Medicine (V.K.T., M.H.P., J.H.W., S.J.A., K.A.), Massachusetts General Hospital, Harvard Medical School, Boston; and Massachusetts General Physicians Organization, Boston (M.K.H., M.H.P., S.J.A., J.B.W., T.G.F., J.H.W.)."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(06)69208-8"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000031"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/12.suppl_B.5"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.90.2.830"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2011.08.030"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2006.05.021"},{"key":"e_1_3_2_8_2","first-page":"1486","article-title":"ACC\/AHA guidelines for the management of patients with valvular heart disease. A report of the American College of Cardiology\/American Heart Association. Task Force on practice guidelines (committee on management of patients with valvular heart disease).","volume":"32","author":"Nishimura RA","year":"1998","unstructured":"Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP III, Guyton RA, O\u2019Gara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM III, Thomas JD. ACC\/AHA guidelines for the management of patients with valvular heart disease. A report of the American College of Cardiology\/American Heart Association. Task Force on practice guidelines (committee on management of patients with valvular heart disease). J Am Coll Cardiol. 1998;32:1486\u20131588.","journal-title":"J Am Coll Cardiol"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2007.05.003"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2012.03.006"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2013.8972"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2015.10.090"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2007.02.048"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.111.961813"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2012-3355"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.115.002393"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2015.02.063"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2015.07.016"},{"key":"e_1_3_2_19_2","first-page":"71","article-title":"Variation in the use of echocardiography.","volume":"2","author":"Lucas FL","year":"1999","unstructured":"Lucas FL, Wennberg DE, Malenka DJ. Variation in the use of echocardiography. Eff Clin Pract. 1999;2:71\u201375.","journal-title":"Eff Clin Pract"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2014.10.003"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1992.03490170055025"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1525-1497.2006.00509.x"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1525-1497.1999.08168.x"}],"container-title":["Circulation: Cardiovascular Imaging"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/CIRCIMAGING.117.006495","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T02:38:58Z","timestamp":1715567938000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCIMAGING.117.006495"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,8]]},"references-count":22,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2017,8]]}},"alternative-id":["10.1161\/CIRCIMAGING.117.006495"],"URL":"https:\/\/doi.org\/10.1161\/circimaging.117.006495","relation":{},"ISSN":["1941-9651","1942-0080"],"issn-type":[{"type":"print","value":"1941-9651"},{"type":"electronic","value":"1942-0080"}],"subject":[],"published":{"date-parts":[[2017,8]]},"assertion":[{"value":"2017-03-29","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2017-06-15","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2017-08-03","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e006495"}}