Introduction

This concept describes the methods of defining and investigating routine electrocardiography as defined in MCHP research.

Definition of Electrocardiogram (ECG or EKG)

An electrocardiogram (ECG or EKG) is a test that records the electrical activity of the heartbeat. An exercise ECG tests the effect of exercise on your heart (De Coster et al., 2007). Individuals without any evidence of heart disease do not require routine EKGs, and this is not recommended as part of a well-person check-up, periodic health examination, or complete physical examination (Katz et al., 2014).

Routine Electrocardiography

In Katz et al., (2014), they investigated routine electrocardiography and measured the percentage of patients aged 18+ who had at least one EKG within two weeks of a complete physical examination. They used the following definitions to develop a methodology for measuring this test, as follows:

They defined EKG as the presence of any of the following tariff codes found in the Medical Services (Physician Claims) data:


• 9836 - HEART AND PERICARDIUM, ELECTROCARDIOGRAM, W INTERPRETATION AND REPORT (12 LEADS)
  
• 9837 - HEART AND PERICARDIUM, ELECTROCARDIOGRAM, W/O INTERPRETATION AND REPORT (12 LEADS)
  
• 9838 - ELECTROCARDIOGRAM, INTERPRETATION AND REPORT BY PHYSICIAN WHO DID NOT TAKE TRAINING 12 LDS

The definition for a complete physical examination is the presence of any of the following tariff codes in Medical Services (Physician Claims) data:


• 8450 - Complete Physical and Gynaecological Exam - Including Cytological Smear - Cervix for Patients Aged 70 years and over
  
• 8460 - Complete Physical and Gynaecological Exam - Excluding Cytological Smear - Cervix for Patients Aged 70 years and over
  
• 8495 - OBS/GYN - Complete Physical and Gynaecological Exam - Including Cytological Smear - Cervix
  
• 8498 - GP - Complete Physical and Gynaecological Exam - Including Cytological Smear - Cervix
  
• 8499 - GP - Complete Physical and Gynaecological Exam - Excluding Cytological Smear - Cervix
  
• 8500 - Complete History and Physical Exam for Patients Aged 75 years and over
  
• 8540 - Complete History and Physical Exam
  
  NOTE: *** tariff code 8594 was not included since it routinely is an exam in hospital and not part of our ambulatory care visit definition.

EXCLUSIONS: - the following exclusion were made:


• exclude patients with a diagnosis of chest pain
  
• exclude patients with a cardiac diagnosis (i.e. myocardial infarction (MI), congestive heart failure (CHF) and ischemic heart disease (IHD) occurring up to 2 years prior to complete physical exam
  
• exclude patients with a diagnosis of hypertension occurring up to 2 years prior to complete physical exam.
  
  Note: The ICD-9 codes for the exclusions noted above are: 401-405, 410-414, 428, and 786.

Routine Electrocardiography Measured in MCHP Research

In Katz et al. (2014), they investigate routine electrocardiography as part of an evaluation of the implementation of Physician Integrated Network (PIN) clinics.

See the section titled Routine Electrocardiography for more information.