Increasing the Appropriateness of Outpatient Imaging: Effects of a Barrier to Ordering Low-Yield Examinations
Increasing the Appropriateness of Outpatient Imaging: Effects of a Barrier to Ordering Low-Yield Examinations
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DOI：
10.1148/radiol.10091228
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发表时间：
2010-06-01
期刊：
影响因子：
19.7
通讯作者：
Thrall, James H.
中科院分区：
文献类型：
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作者：
Vartanians, Vartan M.;Sistrom, Christopher L.;Thrall, James H.
目的：确定计算机化放射科订单输入系统规则的影响，该规则阻止非临床支持人员完成门诊计算机断层扫描、磁共振成像和核医学检查的订单，这些检查最初在订单输入系统中获得低收益决策支持评分。材料和方法：这项符合hipaa的回顾性研究得到了机构审查委员会的批准；知情同意的要求被放弃了。控制组包括从2006年4月到12月提供决策支持的42 737份连续检查订单。研究小组由2007年4月至12月的76 238个连续订单组成。在后一段时间，在订单输入系统中实施了一个新规则：当订单由非临床支持人员下订单时，不能安排具有低收益决策支持分数的考试。为了安排被封锁的检查，负责的临床医生需要亲自登录来完成这个过程。提取、统计和分析系统事件日志和门诊成像程序记录，以确定哪些订购会话导致安排和执行检查，哪些会话导致修改或取消检查。结果与用户状态和决策支持得分相关。使用Cochran-Mantel-Haenszel技术来控制顺序发起者的状态，并允许测试干预对排序事件“命运”影响的显著性。结果：干预后，临床医生直接登录提出检查请求的比例几乎翻了一番，从42 737例中的11 243例（26.31%）增加到76 238例中的41 450例（54.37%）（P < .001）。通过订单输入系统请求的低收益（决策支持得分，1-3）考试的比例从38801的2106（5.43%）下降到65765的1261 (1.92%)（P < .001）。这与具有较高初始决策支持分数的考试请求形成对比，这些考试不受政策变化的影响，并且在变化前后以相同的比率（相对风险，0.988）进行安排。结论：对订单输入系统的业务逻辑进行简单的更改，导致低良率成像检查率大幅下降，临床医生亲自订购的测试百分比显着增加。
Purpose: To determine the effect of a computerized radiology order entry system rule that prevented nonclinician support staff from completing orders for outpatient computed tomographic, magnetic resonance imaging, and nuclear medicine examinations that received initial low-yield decision support scores in the order entry system.Materials and Methods: This retrospective HIPAA-compliant study was approved by the institutional review board; the requirement for informed consent was waived. The control group consisted of 42 737 consecutive orders for examinations in which decision support was provided that were placed from April to December 2006. The study group consisted of 76 238 consecutive orders that were placed from April to December 2007. During the latter time period, a new rule in the order entry system was implemented: Examinations that had low-yield decision support scores could not be scheduled when the orders were placed by nonclinician support staff. To schedule the blocked examinations, the responsible clinician was required to personally log in to complete the process. System event logs and records of outpatient imaging procedures were extracted, counted, and analyzed to determine which ordering sessions resulted in examinations being scheduled and performed and which sessions resulted in modified or cancelled examinations. Results were correlated with user status and decision support scores. The Cochran-Mantel-Haenszel technique was used to control for the status of the order initiator and to allow testing for significance of the effect of the intervention on the "fate" of ordering events.Results: After the intervention, the proportion of total examination requests initiated by clinicians directly logging in almost doubled: from 11 243 (26.31%) of 42 737 to 41 450 (54.37%) of 76 238 examinations (P < .001). The fraction of low-yield (decision support score, 1-3) examinations requested through the order entry system that were later scheduled and performed decreased from 2106 (5.43%) of 38 801 to 1261 (1.92%) of 65 765 (P < .001). This is in contrast to requests for examinations with higher initial decision support scores that were not affected by the policy change and were scheduled at the same rate (relative risk, 0.988) before and after the change.Conclusion: A simple change in the business logic of the order entry system resulted in a substantially decreased rate of low-yield imaging examinations and a markedly increased percentage of tests personally ordered by clinicians.