Gupta Supriya, Klein Kandace, Singh Anand H, Thrall James H
Department of Radiology and Imaging, Medical College of Georgia, Augusta, Georgia.
Department of Radiology and Imaging, Medical College of Georgia, Augusta, Georgia.
J Am Coll Radiol. 2017 May;14(5):615-621. doi: 10.1016/j.jacr.2016.12.011. Epub 2017 Feb 9.
Awareness of imaging utilization increased after implementation of Radiology Order Entry with decision support systems (ROE-DS). Our hypothesis is few exams with low Clinical Appropriateness Score (CAS) on ROE-DS are performed. Clinical indications of exams with CAS less than 3 (9-point scale) were re-reviewed and reports analyzed.
Structured Query Language-based query retrieved exams with CAS less than 3 in ROE-DS from January 2007 to December 2011. Reasons provided by physicians for ordering these exams and reports of exams performed were analyzed. For each indication, number of exams ordered and performed was calculated. Statistical significance was assessed using Student's t test and χ analysis (P < .05).
From 445,984 exams, 12,615 exams (2.8%) had CAS less than 3, and 7,956 exams (63%) were performed. Reasons for ordering of 12,615 low CAS exams were as follows: Requests by physician specialists without further explanation (4,516 = 35.8%), notation of special clinical circumstances (2,877 = 22.8%), requests by nonphysician staff without further explanation (1,383 = 10.9%), absence of suspected finding on previous modality (1,099 = 8.7%), patient preference (737 = 5.8%), and requests based on radiologists' recommendations (706 = 5.6%). Difference between male and female (male < female) preferences for low CAS exams was statistically significant (P < .01). Imaging outcome was highest for extremity MRI cases (66.7%; P < .01).
Less than 3% of exams ordered had low CAS and about two-thirds of these were performed. Most common indication for ordering these exams was physician specialist request based on opinion of medical necessity without specification. Extremity MRI constituted the highest positive findings for low CAS exams performed.
在实施带有决策支持系统的放射学医嘱录入（ROE-DS）后，对影像检查利用的认知有所提高。我们的假设是，ROE-DS上临床适宜性评分（CAS）较低的检查很少被执行。对CAS小于3（9分制）的检查的临床指征进行了重新审查并分析了报告。
基于结构化查询语言的查询检索了2007年1月至2011年12月ROE-DS中CAS小于3的检查。分析了医生开具这些检查的原因以及所执行检查的报告。对于每个指征，计算了开具和执行的检查数量。使用学生t检验和χ分析评估统计学显著性（P <.05）。
在445,984项检查中，12,615项检查（2.8%）的CAS小于3，其中7,956项检查（63%）被执行。开具12,615项低CAS检查的原因如下：医生专家无进一步解释的请求（4,516 = 35.8%）、特殊临床情况的记录（2,877 = 22.8%）、非医生工作人员无进一步解释的请求（1,383 = 10.9%）、先前检查未发现可疑结果（1,099 = 8.7%）、患者偏好（737 = 5.8%）以及基于放射科医生建议的请求（706 = 5.6%）。男性和女性对低CAS检查的偏好差异（男性<女性）具有统计学显著性（P <.01）。四肢MRI检查的成像结果最高（66.7%；P <.01）。
开具的检查中不到3%的检查CAS较低，其中约三分之二被执行。开具这些检查最常见的指征是医生专家基于医疗必要性意见提出的请求，但未详细说明。四肢MRI是执行的低CAS检查中阳性结果最高的。
