Carnevale Tony J, Meng Di, Wang James J, Littlewood Mark
Kaiser Permanente Northwest Sunnyside Medical Center, Portland, Oregon.
Health Information Technology Transformation and Analytics, Kaiser Permanente, Oakland, California.
J Emerg Med. 2015 Jan;48(1):53-7. doi: 10.1016/j.jemermed.2014.07.033. Epub 2014 Oct 7.
Increasing computed tomography (CT) and magnetic resonance imaging (MRI) use in the emergency department (ED) over the last decade is well documented.
Our aim was to assess the impact of an electronic decision support and risk education system (DS-RES) on CT/MRI use.
We conducted an age-, sex-, and risk-adjusted analysis of CT/MRI use and ED and inpatient rebound rates before and after implementation in 2009 at a Kaiser Permanente Northwest medical center.
In the pre period, a total of 12,531 encounters occurred for unique patients within each of 10 chief complaint categories. In the post period, 16,864 total encounters occurred for unique patients within each chief complaint category, 11.4% of patients were at low risk and 24.8% and 63.8% were at medium and high risk, respectively. Adjusted CT/MRI use increased 1.1% (95% confidence interval [CI] 0%-2.3%) between pre and post periods. Among low-risk and medium-risk patients, CT/MRI use decreased by 5.0% (95% CI 2.5%-7.5%) and 10.4% (95% CI 7.9%-12.8%). Among patients at high risk, CT/MRI use increased by 3.9% (95% CI 2.5%-5.3%). The proportion of patients with a 3- or 7-day rebound to the ED or an inpatient facility decreased between pre and post periods by 1.4% (95% CI 0.7%-2.2%) and 0.7% (95% CI 0.2%-1.5%).
DS-RES implementation did not decrease overall CT/MRI rates, but it was associated with a shift in use toward high-risk patients and less patient rebound to the ED and hospital. Further research is required to identify mechanisms underlying imaging utilization shifts.
过去十年间，急诊部门（ED）使用计算机断层扫描（CT）和磁共振成像（MRI）的情况增加，这一点已有充分记录。
我们的目的是评估电子决策支持与风险教育系统（DS - RES）对CT/MRI使用的影响。
我们在西北凯撒医疗中心对2009年实施该系统前后的CT/MRI使用情况、急诊及住院患者的反弹率进行了年龄、性别和风险调整分析。
前期，在10个主要投诉类别中，每个类别针对不同患者共发生了12,531次就诊。后期，每个主要投诉类别针对不同患者共发生了16,864次就诊，11.4%的患者为低风险，24.8%和63.8%的患者分别为中风险和高风险。调整后的CT/MRI使用率在前期和后期之间增加了1.1%（95%置信区间[CI] 0% - 2.3%）。在低风险和中风险患者中，CT/MRI使用率分别下降了5.0%（95% CI 2.5% - 7.5%）和10.4%（95% CI 7.9% - 12.8%）。在高风险患者中，CT/MRI使用率增加了3.9%（95% CI 2.5% - 5.3%）。患者在3天或7天内返回急诊或住院设施的比例在前期和后期之间分别下降了1.4%（95% CI 0.7% - 2.2%）和0.7%（95% CI 0.2% - 1.5%）。
DS - RES的实施并未降低总体CT/MRI使用率，但它与使用向高风险患者转移以及患者返回急诊和医院的情况减少有关。需要进一步研究以确定影像利用转移背后的机制。
