R Sacha Bhatia

University of Toronto, Toronto, Ontario, Canada

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Publications (25)187.27 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: The Choosing Wisely campaign began in the USA in 2012 to encourage physicians and patients to discuss inappropriate and potentially harmful tests, treatments and procedures. Since its inception, the campaign has grown substantially and has been adopted by 12 countries around the world. Of great interest to countries implementing the campaign, is the effectiveness of Choosing Wisely to reduce overutilisation. This article presents an integrated measurement framework that may be used to assess the impact of a Choosing Wisely campaign on physician and provider awareness and attitudes on low-value care, provider practice behaviour and overuse of low-value services. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
    BMJ quality & safety 06/2015; DOI:10.1136/bmjqs-2015-004070 · 3.28 Impact Factor
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    ABSTRACT: There is concern about increasing utilization of low-value health care services, including preoperative testing for lowrisk surgical procedures. We investigated temporal trends, explanatory factors, and institutional and regional variation in the utilization of testing before low-risk procedures. For this retrospective cohort study, we accessed linked population-based administrative databases from Ontario, Canada. A cohort of 1 546 223 patients 18 years or older underwent a total of 2 224 070 low-risk procedures, including endoscopy and ophthalmologic surgery, from Apr. 1, 2008, to Mar. 31, 2013, at 137 institutions in 14 health regions. We used hierarchical logistic regression models to assess patient- and institution-level factors associated with electrocardiography (ECG), transthoracic echocardiography, cardiac stress test or chest radiography within 60 days before the procedure. Endoscopy, ophthalmologic surgery and other low-risk procedures accounted for 40.1%, 34.2% and 25.7% of procedures, respectively. ECG and chest radiography were conducted before 31.0% (95% confidence interval [CI] 30.9%-31.1%) and 10.8% (95% CI 10.8%-10.8%) of procedures, respectively, whereas the rates of preoperative echocardiography and stress testing were 2.9% (95% CI 2.9%-2.9%) and 2.1% (95% CI 2.1%-2.1%), respectively. Significant variation was present across institutions, with the frequency of preoperative ECG ranging from 3.4% to 88.8%. Receipt of preoperative ECG and radiography were associated with older age (among patients 66-75 years of age, for ECG, adjusted odds ratio [OR] 18.3, 95% CI 17.6-19.0; for radiography, adjusted OR 2.9, 95% CI 2.8-3.0), preoperative anesthesia consultation (for ECG, adjusted OR 8.7, 95% CI 8.5-8.8; for radiography, adjusted OR 2.2, 95% CI 2.1-2.2) and preoperative medical consultation (for ECG, adjusted OR 6.8, 95% CI 6.7-6.9; for radiography, adjusted OR 3.6, 95% CI 3.5-3.6). The median ORs for receipt of preoperative ECG and radiography were 2.3 and 1.6, respectively. Despite guideline recommendations to limit testing before low-risk surgical procedures, preoperative ECG and chest radiography were performed frequently. Significant variation across institutions remained after adjustment for patient- and institution-level factors. © 8872147 Canada Inc.
    Canadian Medical Association Journal 06/2015; DOI:10.1503/cmaj.150174 · 5.81 Impact Factor
  • R Sacha Bhatia, Ciara Pendrith, Heather Ross
    Canadian Medical Association Journal 05/2015; DOI:10.1503/cmaj.141479 · 5.81 Impact Factor
  • American Heart Journal 05/2015; DOI:10.1016/j.ahj.2015.04.022 · 4.56 Impact Factor
  • Journal of the American College of Cardiology 03/2015; 65(10):A1324. DOI:10.1016/S0735-1097(15)61324-9 · 15.34 Impact Factor
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    ABSTRACT: The CArdiovascular HEalth in Ambulatory care Research Team (CANHEART) is conducting a unique, population-based observational research initiative aimed at measuring and improving cardiovascular health and the quality of ambulatory cardiovascular care provided in Ontario, Canada. A particular focus will be on identifying opportunities to improve the primary and secondary prevention of cardiovascular events in Ontario's diverse multiethnic population. A population-based cohort comprising 9.8 million Ontario adults ≥20 years in 2008 was assembled by linking multiple electronic survey, health administrative, clinical, laboratory, drug, and electronic medical record databases using encoded personal identifiers. The cohort includes ≈9.4 million primary prevention patients and ≈400 000 secondary prevention patients. Follow-up on clinical events is achieved through record linkage to comprehensive hospitalization, emergency department, and vital statistics administrative databases. Profiles of cardiovascular health and preventive care will be developed at the health region level, and the cohort will be used to study the causes of regional variation in the incidence of major cardiovascular events and other important research questions. Linkage of multiple databases will enable the CANHEART study cohort to serve as a powerful big data resource for scientific research aimed at improving cardiovascular health and health services delivery. Study findings will be shared with clinicians, policy makers, and the public to facilitate population health interventions and quality improvement initiatives. © 2015 American Heart Association, Inc.
    Circulation Cardiovascular Quality and Outcomes 02/2015; 8(2). DOI:10.1161/CIRCOUTCOMES.114.001416 · 5.66 Impact Factor
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    ABSTRACT: Much attention has been paid to the inappropriate underuse of tests and treatments but until recently little attention has focused on the overuse that does not add value for patients and may even cause harm. Choosing Wisely is a campaign to engage physicians and patients in conversations about unnecessary tests, treatments and procedures. The campaign began in the United States in 2012, in Canada in 2014 and now many countries around the world are adapting the campaign and implementing it. This article describes the present status of Choosing Wisely programs in 12 countries. It articulates key elements, a set of five principles, and describes the challenges countries face in the early phases of Choosing Wisely. These countries plan to continue collaboration including developing metrics to measure overuse. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
    BMJ quality & safety 12/2014; 24(2). DOI:10.1136/bmjqs-2014-003821 · 3.28 Impact Factor
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    ABSTRACT: Little is known about variations in the quality of ambulatory care between urban and rural communities for patients with stable ischemic heart disease. The objectives of this study were to understand the effect of rurality on variations of ambulatory processes of care and outcomes for patients with stable ischemic heart disease.
    Circulation Cardiovascular Quality and Outcomes 10/2014; DOI:10.1161/CIRCOUTCOMES.114.001076 · 5.66 Impact Factor
  • R Sacha Bhatia, Wendy Levinson, Douglas S Lee
    BMJ quality & safety 10/2014; 24(2). DOI:10.1136/bmjqs-2014-003605 · 3.28 Impact Factor
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    ABSTRACT: This study sought to prospectively study the impact of an appropriate use criteria (AUC)-based educational intervention on outpatient transthoracic echocardiography (TTE) ordering by physicians-in-training.
    JACC Cardiovascular Imaging 08/2014; 7(9). DOI:10.1016/j.jcmg.2014.04.014 · 6.99 Impact Factor
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    ABSTRACT: Hospital admission rates for patients with heart failure (HF) presenting for emergency department (ED) care vary, and the implications of direct discharge home from the ED are unknown. We examined whether patients treated in hospitals with low admission rates exhibit higher rates of repeat ED visits, hospital readmissions and death.
    BMJ quality & safety 07/2014; DOI:10.1136/bmjqs-2014-002816 · 3.28 Impact Factor
  • David M Dudzinski, R Sacha Bhatia, Rory B Weiner
    JAMA Internal Medicine 07/2014; 174(7):1195-1196. DOI:10.1001/jamainternmed.2014.1440 · 13.25 Impact Factor
  • Journal of the American College of Cardiology 04/2014; 63(12):A1233. DOI:10.1016/S0735-1097(14)61233-X · 15.34 Impact Factor
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    ABSTRACT: We previously demonstrated that an Appropriate Use Criteria (AUC)-based educational intervention reduced inappropriate transthoracic echocardiograms (TTE) on an inpatient medical service. Whether improved TTE ordering is sustained after discontinuation of the intervention is unknown. We conducted a prospective, time series analysis of an educational intervention designed to reduce inappropriate TTE. Ordering patterns during the intervention were compared with a preintervention control period and a postintervention period. The goal of the present analysis was to determine the TTE ordering patterns after discontinuation of the educational intervention. The primary outcome was the proportion of inappropriate TTEs. Using the 2011 AUC 99.2% of all TTEs were classifiable. Compared to the control, there was a 26% reduction in the number of TTEs ordered per day during the intervention (3.9 vs. 2.9 TTEs, P < 0.001), but no significant difference between the intervention and postintervention periods (2.9 vs. 3.1, P = 0.23). The intervention produced a decrease in the inappropriate TTE rate and an increase in the appropriate TTE rate. Compared to the intervention, in the postintervention period the rate of inappropriate TTEs increased (5% vs. 11%, P = 0.01) and appropriate TTEs decreased (93% vs. 86%, P = 0.008). The postintervention rate of inappropriate TTEs was similar to the preintervention control period (11% vs. 13%, P = 0.23). Following completion of an AUC-based educational intervention the proportion of inappropriate TTEs increased to the preintervention level. The long-term success of an intervention designed to improve appropriate utilization of TTE requires a sustained effort of education and feedback.
    Echocardiography 01/2014; 31(8). DOI:10.1111/echo.12505 · 1.25 Impact Factor
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    ABSTRACT: After identifying that significant care gaps exist within the management of atrial fibrillation (AF), a patient-focused tool was developed to help patients better assess and manage their AF. This tool aims to provide education and awareness regarding the management of symptoms and stroke risk associated with AF, while engaging patients to identify if their condition is optimally managed and to become involved in their own care. An interdisciplinary group of health care providers and designers worked together in a participatory design approach to develop the tool with input from patients. Usability testing was completed with 22 patients of varying demographics to represent the characteristics of the patient population. The findings from usability testing interviews were used to further improve and develop the tool to improve ease of use. A physician-facing tool was also developed to help to explain the tool and provide a brief summary of the 2012 Canadian Cardiovascular Society atrial fibrillation guidelines. By incorporating patient input and human-centered design with the knowledge, experience, and medical expertise of health care providers, we have used an approach in developing the tool that tries to more effectively meet patients' needs.
    Patient Preference and Adherence 11/2013; 7:1139-46. DOI:10.2147/PPA.S51285 · 1.49 Impact Factor
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    ABSTRACT: OBJECTIVES: This study sought to prospectively study the impact of an appropriate use criteria (AUC)-based educational intervention on transthoracic echocardiography (TTE) ordering among house staff on the inpatient general internal medicine service at an academic medical center. BACKGROUND: AUC for TTE were developed in response to concerns about inappropriate use of TTE. To date, educational interventions based on the AUC to reduce inappropriate use of TTE have not been prospectively studied. METHODS: A prospective, time series analysis of an educational intervention was conducted and then compared with TTE ordering on the same medical service during a control period. The intervention consisted of: 1) a lecture to house staff on the 2011 AUC for TTE; 2) a pocket card that applied the AUC to common clinical scenarios; and 3) biweekly e-mail feedback regarding ordering behavior. TTE ordering was tracked over the intervention period on a daily basis and feedback reports were e-mailed at 2-week intervals. The primary outcome was the proportion of inappropriate and appropriate TTE ordered during the intervention period. RESULTS: Of all TTEs ordered in the control and study periods, 99% and 98%, respectively, were classifiable using the 2011 AUC. During the study period, there was a 26% reduction in the number of TTE ordered per day compared with the number ordered during the control period (2.9 vs. 3.9 TTE, p < 0.001). During the study period, the proportion of inappropriate TTE was significantly lower (5% vs. 13%, p < 0.001) and the proportion of appropriate TTE was significantly higher (93% vs. 84%, p < 0.001). CONCLUSIONS: A simple educational intervention produced a significant reduction in the proportion of inappropriate TTE and increased the proportion of appropriate TTE ordered on an inpatient academic medical service. This study provides a practical approach for using the AUC to reduce the number of inappropriate TTE. Further study in other practice environments is warranted.
    JACC. Cardiovascular imaging 04/2013; 6(5). DOI:10.1016/j.jcmg.2013.01.010 · 6.99 Impact Factor
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    ABSTRACT: The purpose of this study was to examine utilization and growth in echocardiography among the general population of Ontario between 2001 and 2009. The age- and sex-adjusted rates of echocardiography grew from 39.1 per 1,000 persons in 2001 to 59.9 per 1,000 persons in 2009, for an annual rate of increase of 5.5%. Repeat echocardiograms increased at a rate of 10.6% per year and accounted for 25.3% of all procedures in 2009 as compared to 18.5% in 2002. While significant increases in echocardiography utilization were observed, opportunities may exist to improve the clinical utility of the echocardiograms performed in Ontario.
    JACC. Cardiovascular imaging 04/2013; 6(4):515-22. DOI:10.1016/j.jcmg.2012.10.026 · 6.99 Impact Factor
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    ABSTRACT: BACKGROUND: The 2008 appropriate use criteria (AUC) for stress echocardiographic (SE) examinations were revised in 2011 to cover a wider range of scenarios of use. Data comparing the 2008 and 2011 AUC for SE are limited. METHODS: A retrospective chart review of SE studies performed at an academic medical center was conducted, and ordering of SE studies was assessed using the 2008 and 2011 AUC. RESULTS: A total of 252 consecutive SE studies performed in 2011 were reviewed. The 2008 AUC classified 126 SE studies (50%), and the 2011 AUC classified 221 SE studies (88%) (P < .001). Of all SE studies, 106 (42%) were performed as part of evaluations for noncardiac solid-organ transplantation. The majority of these studies (79%) were classified as inappropriate using the 2011 AUC and were not classifiable using the 2008 AUC. Of the 146 SE studies performed for other reasons, 69% were appropriate and 22% were inappropriate using the 2011 AUC. Inappropriate SE studies for both the general nontransplant and noncardiac solid-organ transplantation populations were nearly exclusively ordered for perioperative assessment with normal functional capacity. The SE studies that remained unclassified by the 2011 AUC were related to the assessment of specialized cardiac conditions, including hypertrophic cardiomyopathy and follow-up after heart transplantation. CONCLUSIONS: The 2011 AUC classify a significantly greater proportion of SE studies compared with the 2008 AUC. Most of the reclassified SE studies using the 2011 AUC were inappropriate and were ordered for perioperative assessments in patients with normal functional capacity.
    Journal of the American Society of Echocardiography: official publication of the American Society of Echocardiography 01/2013; DOI:10.1016/j.echo.2012.12.001 · 3.99 Impact Factor
  • The Canadian journal of cardiology 09/2012; 28(5):S328-S329. DOI:10.1016/j.cjca.2012.07.553 · 3.94 Impact Factor
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    ABSTRACT: The 2007 Appropriate Use Criteria (AUC) for echocardiography was revised in 2011 to cover a wider range of scenarios of use. Previous studies of the 2007 AUC found a relatively large number of unclassified transthoracic echocardiograms (TTEs). We conducted a retrospective chart review comparing TTE usage in three clinical environments: academic inpatient, academic outpatient, and community outpatient. We assessed the TTE ordering behavior using both the 2007 and 2011 AUC. We reviewed 150 consecutive TTEs performed in 2011 in each of the three practice settings (total 450). Using the 2007 AUC, 347 TTEs (77%) were classifiable, and, using the 2011 AUC, 441 TTEs (98%) were classifiable (P < .001). Of the classified studies, the percentage of appropriate TTEs using the 2007 AUC was 83% and using the 2011 AUC was 71% (P < .001). Using the 2007 and 2011 AUC, the percentage of inappropriate TTEs was 17% and 22% (P = .14), and the percentage of uncertain TTEs was 0% and 7% (P < .001), respectively. The rate of inappropriate studies was greatest in the outpatient academic medical center (30%), followed by the outpatient community health center (21%) and the inpatient academic medical center (14%; P = .004). The 2011 AUC classified a significantly greater proportion of TTEs than the 2007 AUC across a variety of practice settings. The rate of appropriate TTEs was lower using the 2011 AUC, and the appropriateness ratings varied by clinical setting. These findings suggest that the expanded AUC offer an opportunity for improvement in TTE usage.
    Journal of the American Society of Echocardiography: official publication of the American Society of Echocardiography 08/2012; 25(11):1162-9. DOI:10.1016/j.echo.2012.07.018 · 3.99 Impact Factor

Publication Stats

915 Citations
187.27 Total Impact Points


  • 2006–2015
    • University of Toronto
      • • Department of Medicine
      • • Division of Cardiology
      Toronto, Ontario, Canada
  • 2014
    • Women's College Hospital
      Toronto, Ontario, Canada
  • 2013–2014
    • Massachusetts General Hospital
      Boston, Massachusetts, United States
  • 2012–2013
    • University of Massachusetts Boston
      Boston, Massachusetts, United States
  • 2011–2013
    • Harvard University
      Cambridge, Massachusetts, United States
  • 2009
    • Institute for Clinical Evaluative Sciences
      Toronto, Ontario, Canada