提高质量以节省时间的干预措施，以增加临床决策支持工具的使用，从而减少在安全网式医疗体系中低价值的诊断性影像学检查。

Quality improvement time-saving intervention to increase use of a clinical decision support tool to reduce low-value diagnostic imaging in a safety net health system.

机构信息

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.

出版信息

BMJ Open Qual. 2021 Feb;10(1). doi: 10.1136/bmjoq-2020-001076.

DOI:10.1136/bmjoq-2020-001076

PMID:33579745

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7883856/

Abstract

IMPORTANCE

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.

OBJECTIVE

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.

INTERVENTION

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.

MAIN OUTCOMES AND MEASURES

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).

RESULTS

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).

CONCLUSION

Workflow time-saving interventions may increase physician engagement with CDS tools and have potential to improve practice patterns.

摘要

重要性

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。

目的

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。