Dunne Ruth M, Ip Ivan K, Abbett Sarah, Gershanik Esteban F, Raja Ali S, Hunsaker Andetta, Khorasani Ramin
From the Center for Evidence-Based Imaging (R.M.D., I.K.I., E.F.G., A.S.R., R.K.), Department of Radiology (R.M.D., I.K.I., E.F.G., A.S.R., A.H., R.K.), Department of Medicine (I.K.I., E.F.G.), Department of Emergency Medicine (A.S.R.), and Brigham and Women's Physician Organization (S.A.), Brigham and Women's Hospital, Harvard Medical School, 20 Kent St, 2nd Floor, Boston, MA 02120.
Radiology. 2015 Jul;276(1):167-74. doi: 10.1148/radiol.15141208. Epub 2015 Feb 13.
To determine the effect of clinical decision support (CDS) on the use and yield of inpatient computed tomographic (CT) pulmonary angiography for acute pulmonary embolism (PE).
This HIPAA-compliant, institutional review board-approved study with waiver of informed consent included all adults admitted to a 793-bed teaching hospital from April 1, 2007, to June 30, 2012. The CDS intervention, implemented after a baseline observation period, informed providers who placed an order for CT pulmonary angiographic imaging about the pretest probability of the study based on a validated decision rule. Use of CT pulmonary angiographic and admission data from administrative databases was obtained for this study. By using a validated natural language processing algorithm on radiology reports, each CT pulmonary angiographic examination was classified as positive or negative for acute PE. Primary outcome measure was monthly use of CT pulmonary angiography per 1000 admissions. Secondary outcome was CT pulmonary angiography yield (percentage of CT pulmonary angiographic examinations that were positive for acute PE). Linear trend analysis was used to assess for effect and trend differences in use and yield of CT pulmonary angiographic imaging before and after CDS.
In 272 374 admissions over the study period, 5287 patients underwent 5892 CT pulmonary angiographic examinations. A 12.3% decrease in monthly use of CT pulmonary angiography (26.0 to 22.8 CT pulmonary angiographic examinations per 1000 admissions before and after CDS, respectively; P = .008) observed 1 month after CDS implementation was sustained over the ensuing 32-month period. There was a nonsignificant 16.3% increase in monthly yield of CT pulmonary angiography or percentage of CT pulmonary angiographic examinations positive for acute PE after CDS (P = .65).
Implementation of evidence-based CDS for inpatients was associated with a 12.3% immediate and sustained decrease in use of CT pulmonary angiographic examinations in the evaluation of inpatients for acute PE. for this article.
确定临床决策支持（CDS）对急性肺栓塞（PE）住院患者计算机断层扫描（CT）肺血管造影的使用情况及检出率的影响。
本研究符合健康保险流通与责任法案（HIPAA）要求，经机构审查委员会批准且无需知情同意书，纳入了2007年4月1日至2012年6月30日期间入住一家拥有793张床位的教学医院的所有成年患者。在基线观察期后实施CDS干预，根据经过验证的决策规则，告知开具CT肺血管造影成像检查单的医护人员该检查的检查前概率。本研究获取了行政数据库中的CT肺血管造影使用情况及入院数据。通过在放射学报告上使用经过验证的自然语言处理算法，将每次CT肺血管造影检查分类为急性PE阳性或阴性。主要结局指标是每1000例入院患者中CT肺血管造影的月使用量。次要结局是CT肺血管造影的检出率（急性PE阳性的CT肺血管造影检查的百分比）。采用线性趋势分析评估CDS前后CT肺血管造影成像使用情况及检出率的效应和趋势差异。
在研究期间的272374例入院患者中，5287例患者接受了5892次CT肺血管造影检查。CDS实施1个月后，CT肺血管造影的月使用量下降了12.3%（CDS实施前后分别为每1000例入院患者26.0次和22.8次CT肺血管造影检查；P = 0.008），并在随后的32个月内持续下降。CDS实施后，CT肺血管造影的月检出率或急性PE阳性的CT肺血管造影检查的百分比有16.3%的增加，但差异无统计学意义（P = 0.65）。
对住院患者实施基于证据的CDS与在评估住院患者急性PE时CT肺血管造影检查的使用量立即且持续下降12.3%相关。
