Center for Evidence-Based Imaging, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
J Am Med Inform Assoc. 2022 Oct 7;29(11):1870-1878. doi: 10.1093/jamia/ocac132.
This study aimed is to: (1) extend the Integrating the Biology and the Bedside (i2b2) data and application models to include medical imaging appropriate use criteria, enabling it to serve as a platform to monitor local impact of the Protecting Access to Medicare Act's (PAMA) imaging clinical decision support (CDS) requirements, and (2) validate the i2b2 extension using data from the Medicare Imaging Demonstration (MID) CDS implementation.
This study provided a reference implementation and assessed its validity and reliability using data from the MID, the federal government's predecessor to PAMA's imaging CDS program. The Star Schema was extended to describe the interactions of imaging ordering providers with the CDS. New ontologies were added to enable mapping medical imaging appropriateness data to i2b2 schema. z-Ratio for testing the significance of the difference between 2 independent proportions was utilized.
The reference implementation used 26 327 orders for imaging examinations which were persisted to the modified i2b2 schema. As an illustration of the analytical capabilities of the Web Client, we report that 331/1192 or 28.1% of imaging orders were deemed appropriate by the CDS system at the end of the intervention period (September 2013), an increase from 162/1223 or 13.2% for the first month of the baseline period, December 2011 (P = .0212), consistent with previous studies.
The i2b2 platform can be extended to monitor local impact of PAMA's appropriateness of imaging ordering CDS requirements.
本研究旨在：（1）扩展整合生物学和床边（i2b2）数据和应用模型，以纳入医学成像适当使用标准，使其能够成为监测保护医疗保险法案（PAMA）成像临床决策支持（CDS）要求对当地影响的平台，以及（2）使用 Medicare Imaging Demonstration（MID）CDS 实施的数据验证 i2b2 扩展。
本研究提供了一个参考实现，并使用 Medicare Imaging Demonstration（MID）的数据评估其有效性和可靠性，MID 是 PAMA 成像 CDS 计划之前联邦政府的成像 CDS 计划。星型模式扩展到描述成像订单提供者与 CDS 的交互。添加了新的本体论，以实现医学成像适当性数据到 i2b2 架构的映射。z-比检验用于检验两个独立比例之间差异的显著性。
参考实现使用了 26327 个用于成像检查的订单，这些订单被持久化到修改后的 i2b2 架构中。作为 Web 客户端分析功能的说明，我们报告在干预期结束时（2013 年 9 月），CDS 系统认为 331/1192 或 28.1%的成像订单是适当的，而在基线期的第一个月（2011 年 12 月）为 162/1223 或 13.2%，这与之前的研究一致（P=0.0212）。
i2b2 平台可扩展以监测 PAMA 成像订单 CDS 要求适当性的当地影响。
