Patient crossover and potentially avoidable repeat computed tomography exams across a health information exchange.
Patient crossover and potentially avoidable repeat computed tomography exams across a health information exchange.
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在健康信息交换过程中，患者交叉和可能可以避免的重复计算机断层扫描检查。
DOI：
10.1093/jamia/ocw035
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发表时间：
2017
期刊：
影响因子：
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通讯作者：
Shapiro,JasonS
中科院分区：
文献类型：
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作者：
Slovis,BenjaminH;Lowry,Tina;Delman,BradleyN;Beitia,AntonOscar;Kuperman,Gilad;DiMaggio,Charles;Shapiro,JasonS
目的：本研究的目的是测量在纽约市建立的健康信息交换（HIE）中进行的重复计算机断层扫描（CT）扫描的数量。长期目标是建立一个基于HIE的重复CT警报系统，以减少潜在的可避免的重复CTs.Methods：这项回顾性队列分析是基于2009年3月至2012年7月之间进行的HIE CT研究记录。计算了进行CT的数量、接受CT的患者总数以及对每例患者进行CT的医院位置。使用之前描述的由作者之一建立的过程，将医院特定的专有CT代码映射到逻辑观察标识符名称和代码（LOINC®）标准术语，以进行研究中心间比较。然后计算每个唯一patient.Results：349321例患者进行了717231次CT，其中重复CT使用相同LOINC代码的位置数。在这些患者中，339 821例在单一位置进行了所有成像研究，占668 938 CT。其中，9500例患者在多个位置进行了48293次CT检查。其中，6284例患者在多个位置使用相同的LOINC代码进行了24978次CT。相同的LOINC代码的研究之间的中位时间为232天（范围为0至1227），但是，1327在7天内进行，5000在30 days.Conclusions：一小部分（3%）我们的队列进行了CT在一个以上的位置，但这代表了大量的扫描（48 293）。值得注意的是，这些CT中有一部分（51.7%）共享相同的LOINC代码，可能代表了潜在可避免的研究，尤其是在短时间内完成的研究。这是一个可解决的问题，未来可以利用基于HIE的警报来减少可能避免的CT扫描。
Objective:The purpose of this study was to measure the number of repeat computed tomography (CT) scans performed across an established health information exchange (HIE) in New York City. The long-term objective is to build an HIE-based duplicate CT alerting system to reduce potentially avoidable duplicate CTs.Methods:This retrospective cohort analysis was based on HIE CT study records performed between March 2009 and July 2012. The number of CTs performed, the total number of patients receiving CTs, and the hospital locations where CTs were performed for each unique patient were calculated. Using a previously described process established by one of the authors, hospital-specific proprietary CT codes were mapped to the Logical Observation Identifiers Names and Codes (LOINC®) standard terminology for inter-site comparison. The number of locations where there was a repeated CT performed with the same LOINC code was then calculated for each unique patient.Results:There were 717 231 CTs performed on 349 321 patients. Of these patients, 339 821 had all of their imaging studies performed at a single location, accounting for 668 938 CTs. Of these, 9500 patients had 48 293 CTs performed at more than one location. Of these, 6284 patients had 24 978 CTs with the same LOINC code performed at multiple locations. The median time between studies with the same LOINC code was 232 days (range of 0 to 1227); however, 1327 were performed within 7 days and 5000 within 30 days.Conclusions:A small proportion (3%) of our cohort had CTs performed at more than one location, however this represents a large number of scans (48 293). A noteworthy portion of these CTs (51.7%) shared the same LOINC code and may represent potentially avoidable studies, especially those done within a short time frame. This represents an addressable issue, and future HIE-based alerts could be utilized to reduce potentially avoidable CT scans.