Implementation and Evaluation of Imaging Decision Support Incorporating CER

结合 CER 的影像决策支持的实施和评估

• 批准号: 8069748
• 负责人: G SCOTT GAZELLE
• 金额: $ 150万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-30 至 2013-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8069748
• 关键词: Address; Adopted; Adoption; Area; Boston; Clinical; Clinical effectiveness; Communication; Community Hospitals; Computers; Data; Decision Support Systems; Development; Diagnostic Imaging; Education; Electronic Health Record; General Hospitals; Goals; Growth; Health Policy; Healthcare; Healthcare Systems; Hospitals; Housing; Image; Image Analysis; Imaging Techniques; Information Systems; Interdisciplinary Study; Leadership; Letters; Magnetic Resonance Imaging; Massachusetts; Medical; Medicine; Outcome; Outpatients; Patient Preferences; Patients; Physicians; Positron-Emission Tomography; Provider; Radiation; Radiology Specialty; Research; Schedule; Services; Surgical Specialties; Surveys; System; Technology; Testing; Time; Update; Vertebral column; Work; X-Ray Computed Tomography; abstracting; base; clinical practice; comparative effectiveness; cost; effectiveness research; evidence base; health care quality; improved; medical specialties; programs; single photon emission computed tomography

DESCRIPTION (provided by applicant): The proposed research will implement real-time radiology decision support and study its effects on the dissemination and adoption of imaging-related comparative effectiveness research (CER) findings. The development and broad adoption of advanced imaging techniques, including computed tomography (CT), magnetic resonance imaging (MRI), single photon emission computed tomography (SPECT) and positron emission tomography (PET) has dramatically changed the practice of medicine. However, these advances are not without costs: diagnostic imaging represents a large and growing portion of total health care spending in the U.S., and there is concern that a substantial portion of the imaging ordered and performed may be unnecessary. There is also evidence that patient preference may be responsible for at least some growth in imaging. Inappropriate imaging not only adds cost to the healthcare system, it can also cause harm via radiation exposure or over diagnosis, leading to treatments that do not improve patient outcomes. Computer physician order entry (CPOE) that includes robust decision support (DS) has great potential to improve healthcare quality and reduce cost by improving the appropriateness of tests ordered and reducing unnecessary imaging. Use of CPOE-DS to support clinical practice is one of the goals identified for "meaningful use" of electronic health record technology by CMS. The Department of Radiology at MGH was one of the first to develop and implement CPOE with real-time DS for imaging. Our Radiology Order Entry (ROE) system has been in place since 2004 and virtually all advanced imaging is now ordered using the system. ROE use has slowed the growth of imaging utilization and increased appropriateness of studies performed.1 Because ROE was developed in house, it is easily modified to incorporate an ever-evolving evidence base regarding the most appropriate use of imaging in specific clinical scenarios. Recent updates have incorporated imaging-related CER findings and expanded the tests and conditions covered. We will implement ROE at a large community hospital within Partners HealthCare System (PHS). Newton- Wellesley Hospital (NWH) is a full-service medical, surgical and specialty hospital that is fully integrated into the PHS Information Technology system but does not have DS for imaging. NWH and PHS leadership are eager to implement radiology DS, and fully support the current proposal. Working together, we will modify ROE to incorporate new imaging-related CER findings, create a new patient-focused interface and implement the system at NWH. We will conduct extensive surveys of providers and patients using the system to evaluate its acceptability, and we will study the effects of ROE implementation on imaging utilization and appropriateness. The research will contribute much needed data concerning the feasibility, acceptability and effectiveness of clinical decision support as a means to disseminate and adopt imaging-related CER findings, focusing on a large community hospital and several priority conditions. PUBLIC HEALTH RELEVANCE: The research will implement real-time clinical decision support for radiology test ordering at a large community hospital in the Boston area, and study the system's effects on the dissemination and adoption of imaging-related comparative effectiveness research (CER) findings. Clinical decision support for radiology allows relevant information concerning the potential usefulness of an imaging study to be presented to ordering physicians - and patients - in real time. The research will provide important information concerning the feasibility of using such a system at a large community hospital, and also help to understand the impact of clinical decision support on the utilization and appropriateness of imaging studies.

描述（由申请人提供）：拟议的研究将实施实时放射学决策支持，并研究其对成像相关比较有效性研究（CER）结果的传播和采用的影响。先进成像技术的发展和广泛采用，包括计算机断层扫描 (CT)、磁共振成像 (MRI)、单光子发射计算机断层扫描 (SPECT) 和正电子发射断层扫描 (PET)，极大地改变了医学实践。然而，这些进步并非没有代价：诊断成像占美国医疗保健总支出的很大一部分，而且还在不断增长，人们担心订购和执行的成像的很大一部分可能是不必要的。还有证据表明，患者的偏好可能至少在一定程度上促进了影像学的发展。不适当的成像不仅会增加医疗保健系统的成本，还可能因辐射暴露或过度诊断而造成伤害，导致治疗无法改善患者的治疗效果。 包含强大决策支持 (DS) 的计算机医嘱输入 (CPOE) 通过提高所安排检查的适当性和减少不必要的成像，具有提高医疗质量和降低成本的巨大潜力。使用 CPOE-DS 支持临床实践是 CMS 确定的“有意义地使用”电子健康记录技术的目标之一。 MGH 放射科是最早开发和实施具有实时 DS 成像功能的 CPOE 的部门之一。我们的放射学订单输入 (ROE) 系统自 2004 年起就已投入使用，现在几乎所有高级成像都是使用该系统订购的。 ROE 的使用减缓了影像利用率的增长，并提高了所进行研究的适当性。1 由于 ROE 是内部开发的，因此很容易对其进行修改，以纳入关于在特定临床场景中最合适的影像使用的不断发展的证据基础。最近的更新纳入了与成像相关的 CER 结果，并扩大了涵盖的测试和条件。 我们将在合作伙伴医疗保健系统 (PHS) 内的大型社区医院实施 ROE。牛顿-韦尔斯利医院 (NWH) 是一家提供全方位服务的内科、外科和专科医院，完全集成到 PHS 信息技术系统中，但没有用于成像的 DS。 NWH 和 PHS 领导层迫切希望实施放射科 DS，并全力支持当前的提案。我们将共同努力修改 ROE，以纳入新的成像相关 CER 结果，创建新的以患者为中心的界面，并在 NWH 实施该系统。我们将对使用该系统的提供者和患者进行广泛的调查，以评估其可接受性，并且我们将研究 ROE 实施对成像利用率和适当性的影响。该研究将提供有关临床决策支持的可行性、可接受性和有效性的急需数据，作为传播和采用影像相关 CER 结果的手段，重点关注大型社区医院和几个优先条件。 公共健康相关性：该研究将为波士顿地区一家大型社区医院的放射学检查预约实施实时临床决策支持，并研究该系统对成像相关比较有效性研究 (CER) 结果的传播和采用的影响。放射学的临床决策支持可以实时向医生和患者提供有关影像学研究潜在用途的相关信息。该研究将提供有关在大型社区医院使用此类系统的可行性的重要信息，并有助于了解临床决策支持对影像学研究的利用和适当性的影响。