University of California Los Angeles Value-Based Care Research Consortium, Los Angeles, California, USA
University of California Los Angeles Value-Based Care Research Consortium, Los Angeles, California, USA.
BMJ Open Qual. 2021 Feb;10(1). doi: 10.1136/bmjoq-2020-001076.
Electronic health record (EHR) clinical decision support (CDS) tools can provide evidence-based feedback at the point of care to reduce low-value imaging. Success of these tools has been limited partly due to lack of engagement by busy clinicians.
Measure the impact of a time-saving quality improvement intervention to increase engagement with a CDS tool for low back pain imaging ordering.
DESIGN, SETTING AND PARTICIPANTS: We conducted a quasi-experimental difference-in-differences analysis at (BLINDED), examining back pain imaging orders from 29 May 2015 to 07 January 2016. The intervention site was (BLINDED) Emergency Medicine/Urgent Care Center (n=5736) and control sites included all other (BLINDED) hospitals and clinics (n=1621). In May 2015, the Department of Health Services installed a CDS tool that triggered a survey when clinicians ordered an imaging test, generating an 'appropriateness score' based on the American College of Radiology guidelines. Clinicians often bypassed the tool, resulting in 'unscored' tests.
To increase clinician engagement with the tool and decrease the rate of unscored imaging tests, a new policy was implemented at the intervention site on 15 August 2015. If clinicians completed the CDS survey and scored an appropriateness score >3, they could forego a previously mandatory telephone call for pre-imaging utilisation review with the radiology department.
We used EHR data to measure pre-post-intervention differences in: (1) percentage of unscored tests and (2) percentage of tests with high appropriateness scores (>7).
Percentage of unscored tests decreased from 69.4% to 10.4% at the intervention site and from 50.6% to 34.8% at the control sites (between-group difference: -23.3%, p<0.001). Percentage of high scoring tests increased from 26.5% to 75.0% at the intervention site and from 17.2% to 22.7% at the control sites (between-group difference: 19%, p<0.001).
Workflow time-saving interventions may increase physician engagement with CDS tools and have potential to improve practice patterns.
电子健康记录（EHR）临床决策支持（CDS）工具可以在护理点提供基于证据的反馈，以减少低价值的影像学检查。这些工具的成功受到限制，部分原因是忙碌的临床医生缺乏参与。
衡量一项节省时间的质量改进干预措施对增加对用于下背痛影像学检查的 CDS 工具的参与度的影响。
设计、设置和参与者：我们在（BLINDED）进行了一项准实验性差异分析，从 2015 年 5 月 29 日至 2016 年 1 月 7 日检查了背部疼痛影像学检查的订单。干预地点是（BLINDED）急诊医学/紧急护理中心（n=5736），控制地点包括所有其他（BLINDED）医院和诊所（n=1621）。2015 年 5 月，卫生服务部安装了一个 CDS 工具，当临床医生下达影像学检查时，该工具会触发一项调查，根据美国放射学院的指南生成“适宜性评分”。临床医生经常绕过该工具，导致“未评分”的检查。
为了增加临床医生对该工具的参与度并降低未评分影像学检查的比率，2015 年 8 月 15 日在干预地点实施了一项新政策。如果临床医生完成了 CDS 调查并获得了>3 的适宜性评分，则可以免除之前与放射科进行影像学使用前审查的强制性电话。
我们使用电子健康记录数据来衡量干预前后的以下差异：（1）未评分检查的百分比和（2）高适宜性评分（>7）的检查的百分比。
干预组未评分检查的比例从 69.4%降至 10.4%，对照组从 50.6%降至 34.8%（组间差异：-23.3%，p<0.001）。高评分检查的比例从 26.5%增加到 75.0%，对照组从 17.2%增加到 22.7%（组间差异：19%，p<0.001）。
节省工作流程时间的干预措施可能会增加医生对 CDS 工具的参与度，并有可能改善实践模式。
