JOURNAL CLUB: Predictors of Provider Response to Clinical Decision Support: Lessons Learned From the Medicare Imaging Demonstration.
JOURNAL CLUB: Predictors of Provider Response to Clinical Decision Support: Lessons Learned From the Medicare Imaging Demonstration.
复制标题
期刊俱乐部：提供者对临床决策支持反应的预测因素：从医疗保险成像演示中吸取的教训。
DOI：
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发表时间：
2017
期刊：
影响因子：
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通讯作者：
R. Khorasani
中科院分区：
文献类型：
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作者：
I. Ip;Ronilda C. Lacson;K. Hentel;S. Malhotra;Jonathan A. Darer;C. Langlotz;Jonathan Weiss;A. Raja;R. Khorasani
目的
成像临床决策支持（CDS）的有效性各不相同。我们的目的是确定CDS因素有助于成像订单取消或修改。
受试者和方法
这项前后研究是在参加医疗保险成像示范的四个机构中进行的。干预措施是在选定门诊成像程序的订单输入时进行CDS。根据所输入的信息，计算机化警报向供应商显示订单是否不属于准则范围、是否适当、是否不确定适当或是否根据专业协会准则不适当。订单提供商可以覆盖或接受CDS。我们认为可操作的警报是那些可以在医嘱医生中产生立即医嘱行为改变的警报（即，取消不适当的命令或修改不确定是否适当的命令，但建议有替代办法）。卡方和逻辑回归确定了警报后订单取消或修改的预测因素。
结果
总共输入了98，894个放射科订单（干预后为83，114个）。供应商忽略了98.9%，修改了1.1%，并取消了0.03%的订单。与不可操作警报相比，可操作警报的修改率（8.1% vs 0.7%; p < 0.0001）或取消率（0.2% vs 0.02%; p < 0.0001）高出10倍。来自已有影像学CDS的机构的订单取消或修改率比新实施CDS的机构低7倍（1.4% vs 0.2%; p < 0.0001）。在多变量分析中，可操作的警报导致订单取消或修改的可能性高出12倍。预先存在CDS的研究中心的订单被取消或修改的可能性低7.7倍（p < 0.0001）。
结论
使用医疗保险成像演示项目的结果，我们确定了与CDS对提供者成像订购的影响相关的潜在因素;这些发现可能对此类计算机化系统的未来设计产生影响。
OBJECTIVE
The efficacy of imaging clinical decision support (CDS) varies. Our objective was to identify CDS factors contributing to imaging order cancellation or modification.
SUBJECTS AND METHODS
This pre-post study was performed across four institutions participating in the Medicare Imaging Demonstration. The intervention was CDS at order entry for selected outpatient imaging procedures. On the basis of the information entered, computerized alerts indicated to providers whether orders were not covered by guidelines, appropriate, of uncertain appropriateness, or inappropriate according to professional society guidelines. Ordering providers could override or accept CDS. We considered actionable alerts to be those that could generate an immediate order behavior change in the ordering physician (i.e., cancellation of inappropriate orders or modification of orders of uncertain appropriateness that had a recommended alternative). Chi-square and logistic regression identified predictors of order cancellation or modification after an alert.
RESULTS
A total of 98,894 radiology orders were entered (83,114 after the intervention). Providers ignored 98.9%, modified 1.1%, and cancelled 0.03% of orders in response to alerts. Actionable alerts had a 10 fold higher rate of modification (8.1% vs 0.7%; p < 0.0001) or cancellation (0.2% vs 0.02%; p < 0.0001) orders compared with nonactionable alerts. Orders from institutions with preexisting imaging CDS had a sevenfold lower rate of cancellation or modification than was seen at sites with newly implemented CDS (1.4% vs 0.2%; p < 0.0001). In multivariate analysis, actionable alerts were 12 times more likely to result in order cancellation or modification. Orders at sites with preexisting CDS were 7.7 times less likely to be cancelled or modified (p < 0.0001).
CONCLUSION
Using results from the Medicare Imaging Demonstration project, we identified potential factors that were associated with CDS effect on provider imaging ordering; these findings may have implications for future design of such computerized systems.
影响因子：
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作者：
Smith-Bindman R;Lipson J;Marcus R;Kim KP;Mahesh M;Gould R;Berrington de González A;Miglioretti DL
通讯作者：
Miglioretti DL
实时计算机化重复警报系统对计算机断层扫描的利用的影响。
影响因子：
39
作者：
Wasser,ElliotJ;Prevedello,LucianoM;Sodickson,Aaron;Mar,Wenhong;Khorasani,Ramin
通讯作者：
Khorasani,Ramin