Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, United States of America; Yale-New Haven Hospital Center for Outcomes Research and Evaluation, New Haven, CT, United States of America.
Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, United States of America.
Am J Emerg Med. 2021 Jan;39:102-108. doi: 10.1016/j.ajem.2020.01.029. Epub 2020 Jan 17.
To characterize performance among ED sites participating in the Emergency Quality Network (E-QUAL) Avoidable Imaging Initiative for clinical targets on the American College of Emergency Physicians Choosing Wisely list.
This was an observational study of quality improvement (QI) data collected from hospital-based ED sites in 2017-2018. Participating EDs reported imaging utilization rates (UR) and common QI practices for three Choosing Wisely targets: Atraumatic Low Back Pain, Syncope, or Minor Head Injury.
305 ED sites participated in the initiative. Among all ED sites, the mean imaging UR for Atraumatic Low Back Pain was 34.7% (IQR 26.3%-42.6%) for XR, 19.1% (IQR 11.4%-24.9%) for CT, and 0.09% (IQR 0%-0.9%) for MRI. The mean CT UR for Syncope was 50.0% (IQR 38.0%-61.4%). The mean CT UR for Minor Head Injury was 72.6% (IQR 65.6%-81.7%). ED sites with sustained participation showed significant decreases in CT UR in 2017 compared to 2018 for Syncope (56.4% vs 48.0%; 95% CI: -12.7%, -4.1%) and Minor Head Injury (76.3% vs 72.1%; 95% CI: -7.3%, -1.1%). There was no significant change in imaging UR for Atraumatic Back Pain for XR (36.0% vs 33.3%; 95% CI: -5.9%, -0;5%), CT (20.1% vs 17.7%; 95% CI: -5.1%, -0.4%) or MRI (0.8% vs 0.7%, 95% CI: -0.4%, -0.3%).
Early data from the E-QUAL Avoidable Imaging Initiative suggests QI interventions could potentially improve imaging stewardship and reduce low-value care. Further efforts to translate the Choosing Wisely recommendations into practice should promote data-driven benchmarking and learning collaboratives to achieve sustained practice improvement.
为了对参与急诊质量网络（E-QUAL）可避免成像倡议的急诊（ED）站点的表现进行评估，该倡议针对的是美国急诊医师学会选择明智清单上的临床目标。
这是一项观察性的质量改进（QI）研究，数据来自 2017 年至 2018 年期间的医院 ED 站点。参与的 ED 站点报告了三个选择明智目标的成像利用率（UR）和常见 QI 实践：非创伤性下腰痛、晕厥或轻度头部损伤。
305 个 ED 站点参与了该倡议。在所有 ED 站点中，非创伤性下腰痛的 X 光 UR 平均为 34.7%（IQR 26.3%-42.6%），CT 为 19.1%（IQR 11.4%-24.9%），MRI 为 0.09%（IQR 0%-0.9%）。晕厥的 CT UR 平均为 50.0%（IQR 38.0%-61.4%）。轻度头部损伤的 CT UR 平均为 72.6%（IQR 65.6%-81.7%）。持续参与的 ED 站点在 2017 年与 2018 年相比，晕厥的 CT UR 显著下降（56.4%比 48.0%；95%CI：-12.7%，-4.1%）和轻度头部损伤（76.3%比 72.1%；95%CI：-7.3%，-1.1%）。X 光（36.0%比 33.3%；95%CI：-5.9%，-0；5%）、CT（20.1%比 17.7%；95%CI：-5.1%，-0.4%）或 MRI（0.8%比 0.7%；95%CI：-0.4%，-0.3%）的非创伤性腰痛的成像 UR 没有显著变化。
E-QUAL 可避免成像倡议的早期数据表明，QI 干预措施可能有助于改善成像管理，减少低价值的医疗服务。进一步努力将选择明智的建议转化为实践，应该促进基于数据的基准测试和学习合作，以实现持续的实践改进。
