1 Department of Radiology and Radiological Sciences, Vanderbilt University School of Medicine, 1161 21st Ave S, R1315 MCN, Nashville, TN 37232-2675.
AJR Am J Roentgenol. 2013 Nov;201(5):1049-56. doi: 10.2214/AJR.12.10393.
During this study, we instituted a phased quality improvement initiative designed to educate referring clinicians and departmental radiologists about the recommendations of the American College of Radiology (ACR) Appropriateness Criteria for dual-phase (without and with contrast material) head CT examinations. The primary aims of the study were to evaluate whether the quality improvement initiative was associated with an improvement in ACR Appropriateness Criteria appropriateness ratings and a reduction in the number of unindicated dual-phase head CT examinations performed. A secondary aim was to assess the impact of the quality improvement initiative on health care costs.
This study included-with the exception of the examinations performed during a 3-month training period-all single- and dual-phase head CT examinations performed of adult patients at a tertiary care medical center from January 2009 through October 2011. Both inpatients and outpatient examinations were included. There were no exclusion criteria.
Implementation of the initiative enhanced patient safety and reduced health care costs by achieving a significant reduction (p = 0.006) in the number of unindicated dual-phase head CT examinations performed from a median number of 40 per month to 17 per month.
Although there are potential benefits for dual-phase head CT examinations, the medical and economic risks should be measured against these potential benefits. Incorporating the ACR Appropriateness Criteria applies evidence-based medicine to this algorithm. In this outcomes-driven study, the number of unindicated dual-phase head CT examinations was reduced and imaging efficacy improved primarily through physician education and monitoring.
在本研究中，我们实施了分阶段质量改进计划，旨在向转诊临床医生和放射科医生教育关于美国放射学院（ACR）双期（有无对比剂）头部 CT 检查的适宜性标准的建议。该研究的主要目的是评估质量改进计划是否与 ACR 适宜性标准适宜性评分的提高以及不必要的双期头部 CT 检查数量的减少相关。次要目的是评估质量改进计划对医疗成本的影响。
本研究包括-除了在 3 个月的培训期间进行的检查之外-所有在 2009 年 1 月至 2011 年 10 月期间在一家三级保健医疗中心进行的成人患者的单期和双期头部 CT 检查。包括住院患者和门诊患者。没有排除标准。
通过实现不必要的双期头部 CT 检查数量从每月中位数 40 例减少至每月 17 例（p = 0.006），该计划的实施提高了患者安全性并降低了医疗成本。
尽管双期头部 CT 检查具有潜在的益处，但应权衡其潜在益处与医疗和经济风险。将 ACR 适宜性标准应用于该算法是应用循证医学的一种方法。在这项以结果为导向的研究中，主要通过医生教育和监测减少了不必要的双期头部 CT 检查数量并提高了成像效果。
