The Use of Decision Support to Measure Documented Adherence to a National Imaging Quality Measure
The Use of Decision Support to Measure Documented Adherence to a National Imaging Quality Measure
复制标题
DOI：
10.1016/j.acra.2013.10.017
复制
发表时间：
2014-03-01
影响因子：
4.8
通讯作者：
Khorasani, Ramin
中科院分区：
文献类型：
--
作者：
Raja, Ali S.;Gupta, Anurag;Khorasani, Ramin
基本原理和目标：目前的方法来衡量遵守国家成像质量的措施，往往需要资源密集的图表审查。计算机化的决策支持系统可以允许自动捕获这些数据。我们试图确定使用针对测量的临床决策支持来测量对关于肺栓塞的计算机断层扫描肺血管造影（CTPA）的国家质量测量（NQM）的依从性的可行性，以及该系统所需的相关增加的数据捕获负担是否会影响CT的使用和产量。材料和方法：这项机构审查委员会批准的前瞻性队列研究招募了2009年9月1日至2011年11月30日的患者，在急诊科（艾德）的776张床位的四季报成人专用学术医疗中心。我们的干预。由CTPA的NQM靶向临床决策支持工具组成，需要强制输入威尔斯标准和血清D-二聚体水平。主要结果是记录的遵守质量措施之前和之后的干预，和次要结果是CTPAs.Results的使用和产量：共1209例患者：疑似PE（2.0%的58,795艾德访问）成像CTPA在12个月的控制，期间，和1212例患者成像在12个月后的季度期间，实施干预（2.0%的59,478艾德访问，P = 0.84）。基于对提供者注释的结构化审查，记录的NQM基线依从性为56.9%。实施后，记录的依从性增加到75.6%（p <0.01）。CTPA产量保持不变，是10.4%，在控制期间和10.1%的干预后（P = 0.88）。结论：实施临床决策支持工具显着提高记录遵守NQM，使自动测量供应商遵守证据，而不需要：资源密集型图表审查。它不会对CTPA的使用或产率产生不利影响。
Rationale and Objectives: Present methods for measuring adherence to national imaging quality measures often require a resource-intensive chart review. Computerized, decision support systems may allow for automated capture of these data. We sought to determine the feasibility of measuring adherence to a national quality measure (NQM) regarding computed tomography pulmonary angiograms (CTPAs) for pulmonary embolism using measure-targeted clinical decision support and whether the associated increased burden of data captured required by this system would affect the use and yield of CTs.Materials and Methods: This institutional review board-approved prospective cohort study enrolled patients from September 1, 2009, through November 30, 2011, in the emergency department (ED) of a 776-bed quaternary-pare adults-only academic medical center. Our intervention. consisted of an NQM-targeted clinical decision support tool for CTPAs, which required mandatory input of the Wells criteria and serum D-dimer level. The primary outcome was the documented adherence to the quality measure prior and subsequent to the intervention, and the secondary outcomes were the use and yield of CTPAs.Results: A total of 1209 patients with:suspected PE (2.0% of 58,795 ED visits) were imaged by CTPA during the 12-month control,period, and 1212 patients were imaged in the 12 months after the quarter during which the intervention was implemented (2.0% of 59,478 ED visits, P = .84). Documented baseline adherence to the NQM was 56.9% based on a structured review of the provider notes. After implementation, documented adherence increased to 75.6% p < .01). CTPA yield remained unchanged and was 10.4% during the control period and 10.1% after the intervention (P = .88).Conclusions: Implementation of a Clinical decision support tool significantly improved documented adherence to an NQM, enabling automated measurement of provider adherence to evidence without the need: for resource-intensive chart review. It did not adversely affect the use or yield of CTPAs.