Randomized Clinical Trial of a Clinical Decision Support Tool for Improving the Appropriateness Scores for Ordering Imaging Studies in Primary and Specialty Care Ambulatory Clinics
| Autor: | John F. Steiner, Susan M. Shetterly, Richard E. Sharpe, Ted E. Palen |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
medicine.medical_specialty
Specialty Disease cluster Ambulatory Care Facilities Clinical decision support system Medical Order Entry Systems Appropriate Use Criteria 030218 nuclear medicine & medical imaging law.invention 03 medical and health sciences 0302 clinical medicine Randomized controlled trial law Health care medicine Humans Radiology Nuclear Medicine and imaging Practice Patterns Physicians' business.industry General Medicine Decision Support Systems Clinical Magnetic Resonance Imaging Appropriateness criteria 030220 oncology & carcinogenesis Emergency medicine Ambulatory Tomography X-Ray Computed business |
| Zdroj: | American Journal of Roentgenology. 213:1015-1020 |
| ISSN: | 1546-3141 0361-803X |
| DOI: | 10.2214/ajr.19.21511 |
| Popis: | OBJECTIVE. The objective of our study was to evaluate whether the use of a clinical decision support (CDS) tool improved the appropriateness scores of orders for advanced imaging in clinical practice. MATERIALS AND METHODS. We used a stepped-wedge, cluster randomized clinical trial to evaluate the effectiveness of a CDS tool in an integrated health care system. Clinicians entered structured indications for each CT and MRI order, and the indications were electronically scored against appropriateness criteria to assign an appropriateness score. We compared the proportion of orders with adjusted appropriateness scores of 7 or greater (on a 1-9 scale) before and after activation of best practice alerts (BPAs) triggered for orders with low or marginal appropriateness scores. Secondary outcomes included the rate per month of orders for advanced imaging and the proportion of orders for which the radiology department requested changes. RESULTS. Between October 2015 and February 2016, 941 clinicians ordered 22,279 CT or MRI studies that met eligibility criteria. Before activation of the BPA, the mean proportion of appropriate orders (adjusted for time and clinic effect) was 77.0% (95% CI, 75.5-78.4%), which increased to 80.1% (95% CI, 78.7-81.5%) after activation (p = 0.001). There was no significant change in the rate of orders per month for advanced imaging. The proportion of order changes requested by the radiology department decreased from 5.7% (95% CI, 5.6-5.9%) before CDS implementation to 5.3% (95% CI, 5.1-5.5%) after CDS implementation (p < 0.001). CONCLUSION. Using an evidence-based CDS tool in clinical practice was associated with a modest but significant improvement in the appropriateness scores of advanced imaging orders. |
| Databáze: | OpenAIRE |
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