Lessons From the Free-Text Epidemic: Opportunities to Optimize Deployment of Imaging Clinical Decision Support.
Lessons From the Free-Text Epidemic: Opportunities to Optimize Deployment of Imaging Clinical Decision Support.
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DOI：
10.1016/j.jacr.2021.01.002
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发表时间：
2021-03
影响因子：
4.5
通讯作者：
Zafar, Hanna M.
中科院分区：
文献类型：
--
作者：
Fried, Jessica G.;Pakpoor, Jina;Kahn, Charles E., Jr.;Zafar, Hanna M.
2014 年《保护获得医疗保险法案》要求临床医生在订购高级成像程序时参考适当使用标准 (AUC)。当没有适用的结构化指示但 AUC 未评分时，可以使用自由文本顺序指示。我们确定了所有高级成像订单中自由文本指示的比例以及可以映射到单个结构化指示的自由文本指示的比例。首次 AUC 部署后（2017 年 11 月 20 日至 2017 年 12 月 19 日），记录了大型多站点医疗系统中的所有门诊高级诊断成像订单。输入订单后会提示临床医生选择结构化适应症或输入自由文本适应症。我们手动审查了自由文本指征率最高的两种影像学检查：增强 CT 腹部/骨盆和未增强 CT 头部。回归分析检查了评分检查和未评分检查之间患者、影像、背景和提供者层面特征的差异。在所有 39,533 个高级成像程序订单中，系统未对 59%（39,533 个订单中的 23,267 个）进行评分。回归模型 c 统计量 (0.50–0.55) 表明模型不太适合评估评分考试和不评分考试之间的差异。 71%（23,267 次中的 16,440 次）的不计分考试和 42%（39,533 次中的 16,440 次）考试中发现了自由文本指示。对所有 1,693 个腹部/骨盆 CT 和 1,527 个带有自由文本指示的 CT 头部检查的手动审查显示，3,132 个自由文本指示 (97%) 可以映射到单个现有的结构化指示。在所有最初下达的门诊高级成像手术订单中，42% 包括自由文本指示，97% 的手动审核自由文本指示可以映射到单个结构化指示。
The Protecting Access to Medicare Act of 2014 requires clinicians to consult Appropriate Use Criteria (AUC) when ordering advanced imaging procedures. Free-text order indications are available when there is no applicable structured indication but are unscored by the AUC. We determined the proportion of free-text indications among all advanced imaging orders and the proportion of free-text indications that could be mapped to a single structured indication. All outpatient advanced diagnostic imaging orders placed in a large multisite health system were recorded after initial AUC deployment (November 20, 2017, to December 19, 2017). Clinicians were prompted upon order entry to select a structured indication or enter a free-text indication. We manually reviewed the two imaging examinations with the highest rate of free-text indications: enhanced CT abdomen/pelvis and unenhanced CT head. Regression analysis examined differences in patient-, imaging-, context-, and provider-level characteristics between scored and unscored examinations. Among all 39,533 orders for advanced imaging procedures, 59% (23,267 of 39,533) were unscored by the system. The regression model c-statistic (0.50–0.55) demonstrated poor model fit to evaluate for differences between scored and unscored examinations. Free-text indications were found in 71% (16,440 of 23,267) of unscored examinations and 42% (16,440 of 39,533) of all examinations. Manual review of all 1,693 CT abdomen/pelvis and 1,527 CT head examinations with free-text indications revealed that 3,132 free-text indications (97%) could be mapped to a single existing structured indication. Of all initially placed outpatient advanced imaging procedure orders, 42% included free-text indications and 97% of manually reviewed free-text indications could be mapped to a single structured indication.
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DOI：
10.1136/amiajnl-2013-001617
发表时间：
2014-01-01
影响因子：
6.4
作者：
Gupta, Anurag;Raja, Ali S.;Khorasani, Ramin
通讯作者：
Khorasani, Ramin
影响因子：
5
作者：
Raja, Ali S.;Pourjabbar, Sarvenaz;Khorasani, Ramin
通讯作者：
Khorasani, Ramin
影响因子：
4.5
作者：
Brown, A. D.;Kachura, J. R.
通讯作者：
Kachura, J. R.
影响因子：
19.7
作者：
Vartanians, Vartan M.;Sistrom, Christopher L.;Thrall, James H.
通讯作者：
Thrall, James H.
影响因子：
4.8
作者：
Raja, Ali S.;Gupta, Anurag;Khorasani, Ramin
通讯作者：
Khorasani, Ramin