Impact of decision support and accountability tools on adoption of evidence

描述（由申请人提供）：虽然US、CT和MRI等成像技术的技术进步对患者护理做出了巨大贡献，但与其使用相关的支出迅速增加，并且成像使用中存在显著的实践模式差异。大量的成像检查可能是不必要的或多余的，使患者暴露于过量的辐射和医疗系统的重大浪费。越来越多的比较有效性研究（CER）的证据存在成像，但需要快速采用，以实现其效益。本研究将实施并评估嵌入计算机化医嘱输入（CPOE）中的实时临床决策支持系统（DSS）的影响，该系统可作为加快传播速度和采用成像相关CER结果的工具。具体目标是：目标1：开发教育内容，作为自动成像DSS和相关问责工具提供，用于三个CER知情的循证指南（EBG）。目标二：在两家大型医疗机构部署基于EBG的DSS、相关的既往检查DSS和问责工具，其中一家拥有完善的成像临床决策支持系统，另一家拥有HIT基础设施，但没有当前的成像DSS。目标3：评估DSS实施的结果，包括成像CPOE的有意义使用和DSS的采用，系统在促进循证实践方面的有效性，以及与CER知情结果相比图像排序的适当性。目标4：评估增加问责工具在多大程度上改善了CER的实际应用。指南中提供的事实证据将用于生成可计算的表示，该表示将集成到两个试点卫生系统的图像排序工作流程中。有关成像订购行为（包括取消、过期和更改的订单）的数据将收集在中央成像存储库中。主要结局指标将是图像顺序遵守循证指南中建议的程度，以及用户接受或忽略决策支持建议或更改为不同成像模式的程度。 公共卫生相关性：使用成像服务的增长极大地促进了患者护理，但也引起了对可能不必要或多余的成像检查的担忧，使患者暴露于不必要的辐射中，并使医疗系统遭受重大浪费。该项目将使用医疗信息技术工具（HIT），如决策支持，帮助临床医生在请求成像研究时做出基于证据的决策，以提高质量并减少浪费。如果有效，该项目将成为加快采用成像相关比较有效性研究结果以改善医学实践的步伐的典范。

DESCRIPTION (provided by applicant): While technologic advances in imaging techniques such as US, CT, and MRI have contributed tremendously to patient care, expenditures related to their use have increased rapidly and significant practice pattern variation exists in imaging utilization. Substantial numbers of imaging examinations may be unnecessary or redundant, exposing patients to excess radiation and the medical system to significant waste. Growing amounts of comparative effectiveness research (CER)-informed evidence exists for imaging, but rapid adoption is required to realize its benefits. This study will implement and assess impact of a real-time clinical decision support system (DSS) embedded in computerized physician order entry (CPOE) as a vehicle for increasing the pace of dissemination and adoption of imaging-related CER findings. The specific aims are to: Aim 1: Develop educational content to be delivered as automated imaging DSS and related accountability tools for three CER-informed evidence based guidelines (EBGs). Aim 2: Deploy the EBG-based DSS, relevant prior examination DSS, and accountability tools in two large healthcare institutions, one with well-established imaging clinical decision support systems and one with HIT infrastructure without current imaging DSS. Aim 3: Assess the outcome of DSS implementation including meaningful use of imaging CPOE and adoption of DSS, the efficacy of the system in promoting evidence-based practice, and the appropriateness of image ordering compared to CER-informed findings. Aim 4: Assess the extent to which the addition of accountability tools improves adoption of CER into practice. The factual evidence presented in the guidelines will be used to generate a computable representation that is integrated into the image ordering workflow at two pilot site health systems. Data about imaging ordering behavior (including canceled, expired and changed orders) will be collected in a central imaging repository. The primary outcome measure will be the extent to which image orders adhere to the recommendations in the evidence-based guidelines, and the extent to which users accept or ignore the decision support advice or change to a different imaging modality. PUBLIC HEALTH RELEVANCE: The growth in the use of imaging services has contributed tremendously to patient care, but has lead to concerns about potentially unnecessary or redundant imaging examinations, exposing patients to unnecessary radiation and the medical system to significant waste. This project will use healthcare information technology tools (HIT) such as decision support to help clinicians make evidence-based decisions when requesting imaging studies to improve quality and reduce waste. If effective, this project will serve as a model for increasing the pace of adoption of imaging-related comparative effectiveness research findings to improve the practice of medicine.