Awareness of relative CT utilization among peers is not associated with changes in imaging requests among emergency department providers in a large county hospital

Kadakia, Kevin; Pfeifer, Cory M.; Cao, Joseph; O'Connell, Ellen; Kwon, Jeannie K.; Browning, Travis

doi:10.1007/s10140-019-01713-z

Cited by 3 publications

(3 citation statements)

References 15 publications

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“…This trend has held steady over the past several years, and across several jurisdictions, despite the volume and breadth of campaigns and institutional initiatives aimed at reducing "overutilization," or optimizing ordering behavior. Interventions that have focused on optimizing ordering behavior through, for example, increasing guideline adherence through educational campaigns or-as within our study-through audit-and-feedback and peer comparison have demonstrated either poor adherence to evidence-based guidelines, or a lack of impact on measurable outcomes of utilization and yield despite increased guideline adherence [10,13,15,16,[23][24][25]. One study that aimed to evaluate the impact of automated clinical decision support tools (based on predetermined professional society guidelines) on the volume of unnecessary diagnostic imaging found that physicians ignored close to 99% of all computer-generated alerts [23].…”

Section: Discussionmentioning

confidence: 80%

“…The QI measures aimed at reducing, or "optimizing," the use of CTPAs have included physician education, audit-andfeedback, peer comparison, clinical decision support tools, and computerized order entries [9][10][11][12]. While a multitude of research studies have been directed at isolating the optimal combination of QI interventions, many of the interventions with demonstrated success in the initial studies have failed to replicate their initial positive findings in more real-world settings [13][14][15][16].…”

Section: Introductionmentioning

confidence: 99%

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The impact of performance feedback reports on physician ordering behavior in the use of computed tomography pulmonary angiography (CTPA)

Salehi

Jaskolka

et al. 2022

Emerg Radiol

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PurposeThe increased utilization, and potential overutilization, of computed tomography pulmonary angiography (CTPA) is a well-recognized issue within emergency departments (EDs). The objective of this study is to determine the impact of performance feedback reports on CTPA ordering behavior among ED physicians. Methods We conducted a prospective study of the impact of individualized performance feedback reports on the ordering behavior of physicians working at two high-volume community EDs in Ontario, Canada. We generated individualized reports (or "Dashboards") for each ED physician containing detailed feedback and peer comparison for each physician's CTPA ordering. Our baseline pre-intervention period was January 1 to December 31, 2018, and our intervention period was January 1, 2019, to December 31, 2021. We tracked individual and group ordering behavior through the study period. Our primary outcomes are impact of feedback on (1) overall group ordering rate and (2) overall diagnostic yield. Secondary analysis was done to determine the impact of the intervention on those physicians with the highest CTPA utilization rate. Results There was no statistically significant difference in the diagnostic yield of the included physicians in either of the years of the intervention period. There was a statically significant increase in the utilization rate for CTPA from 2018 to 2020 and 2021 from 5.9 to 7.9 and 11.4 CTPAs per 1000 ED visits respectively (p < 0.5). Conclusion Our study found no consistent significant impact of individualized feedback and peer comparison on physician ordering of CTPAs. This points to a potentially greater impact of environmental and institutional factors, as opposed to physician-targeted quality improvement measures, on physician ordering behavior.

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Section: Discussionmentioning

confidence: 80%

Section: Introductionmentioning

confidence: 99%

The impact of performance feedback reports on physician ordering behavior in the use of computed tomography pulmonary angiography (CTPA)

Salehi

Jaskolka

et al. 2022

Emerg Radiol

View full text Add to dashboard Cite

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“…30 Interestingly, audit feedback emerged as a facilitator in our study despite prior studies showing modest or no improvement CTPA use or yield. 31,32 These studies did not incorporate recommendations for best practices in audit feedback including offering multiple comparators and benchmarks for credibility and actionability, providing trends and concrete recommendations, and encouraging concrete and explicit goal setting, which may have limited the effectiveness of audit feedback in these studies. 33 Alternatively, our providers may have verestimated the effect that auditfeedback would have on their practice patterns.…”

Section: Facilitatorsmentioning

confidence: 99%

Provider Perspectives on the Use of Evidence‐based Risk Stratification Tools in the Evaluation of Pulmonary Embolism: A Qualitative Study

Westafer

Kunz

Bugajska

et al. 2020

Academic Emergency Medicine

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Objectives Providers often pursue imaging in patients at low risk of pulmonary embolism (PE), resulting in imaging yields <10% and false‐positive imaging rates of 10% to 25%. Attempts to curb overtesting have had only modest success and no interventions have used implementation science frameworks. The objective of this study was to identify barriers and facilitators to the adoption of evidence‐based diagnostic testing for PE. Methods We conducted semistructured interviews with a purposeful sample of providers. An interview guide was developed using the implementation science frameworks, consolidated framework for implementation research, and theoretical domains framework. Interviews were recorded, transcribed, and analyzed in an iterative process. Emergent themes were identified, discussed, and organized. Results We interviewed 23 providers from four hospital systems, and participants were diverse with regard to years in practice and practice setting. Barriers were predominately at the provider level and included lack of knowledge of the tools, particularly misunderstanding of the validated scoring systems in Wells, as well as risk avoidance and need for certainty. Barriers to prior implementation strategies included the perception of a clinical decision support (CDS) tool for PE as adding steps with little value; most participants reported that they overrode CDS interventions because they had already made the decision. All providers identified institution‐level strategies as facilitators to use, including endorsed guidelines, audit feedback with peer comparison about imaging yield, and peer pressure. Conclusions This exploration of the use of risk stratification tools in the evaluation of PE found that barriers to use primarily exist at the provider level, whereas facilitators to the use of these tools are largely perceived at the level of the institution. Future efforts to promote the evidence‐based diagnosis of PE should be informed by these determinants.

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Quality use of diagnostic imaging in trauma, and the impact on emergency medical practice—a retrospective clinical audit

et al. 2021

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Awareness of relative CT utilization among peers is not associated with changes in imaging requests among emergency department providers in a large county hospital

Cited by 3 publications

References 15 publications

The impact of performance feedback reports on physician ordering behavior in the use of computed tomography pulmonary angiography (CTPA)

The impact of performance feedback reports on physician ordering behavior in the use of computed tomography pulmonary angiography (CTPA)

Provider Perspectives on the Use of Evidence‐based Risk Stratification Tools in the Evaluation of Pulmonary Embolism: A Qualitative Study

Quality use of diagnostic imaging in trauma, and the impact on emergency medical practice—a retrospective clinical audit

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