Effect of Clinical Decision Support on Appropriateness of Advanced Imaging Use Among Physicians-in-Training

Poeran, Jashvant; Mao, Lisa J; Zubizarreta, Nicole; Mazumdar, Madhu; Darrow, Bruce; Genes, Nicholas; Kannry, Joseph L.; Francaviglia, Paul; Kennelly, P; Whitehorn, Jayson; Kilroy, Galen; Garcia, Dairon; Mendelson, David S.

doi:10.2214/ajr.18.19931

Cited by 18 publications

(6 citation statements)

References 20 publications

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“…1). The most frequent reasons for exclusion at full-text level (Additional file 1: Supplementary material 3) were conference abstracts (n = 26) and studies exclusively investigating the appropriateness of requests for diagnostic imaging (n = 13) [19,[50][51][52][53][54][55][56][57][58][59][60][61]. Finally, 50 studies met the predefined inclusion criteria and were included in this scoping review [20][21][22][23].…”

Section: Resultsmentioning

confidence: 99%

Measuring appropriateness of diagnostic imaging: a scoping review

et al. 2023

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In radiology, the justification of diagnostic imaging is a key performance indicator. To date, specific recommendations on the measurement of appropriateness in diagnostic imaging are missing. To map the study literature concerning the definition, measures, methods and data used for analyses of appropriateness in research of diagnostic imaging. We conducted a scoping review in Medline, EMBASE, Scopus and the Cochrane Central Register of Controlled Trials. Two independent reviewers undertook screening and data extraction. After screening 6021 records, we included 50 studies. National guidelines (n = 22/50) or American College of Radiology Appropriateness Criteria (n = 23/50) were used to define and rate appropriateness. 22/50 studies did not provide methodological details about the appropriateness assessment. The included studies varied concerning modality, amount of reviewed examinations (88–13,941) and body regions. Computed tomography (27 studies, 27,168 examinations) was the most frequently analyzed modality, followed by magnetic resonance imaging (17 studies, 6559 examinations) and radiography (10 studies, 7095 examinations). Heterogeneous appropriateness rates throughout single studies (0–100%), modalities, and body regions (17–95%) were found. Research on pediatric and outpatient imaging was sparse. Multicentric, methodologically robust and indication-oriented studies would strengthen appropriateness research in diagnostic imaging and help to develop reliable key performance indicators.

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Section: Resultsmentioning

confidence: 99%

Measuring appropriateness of diagnostic imaging: a scoping review

et al. 2023

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“…Education,73–77 audit and feedback,78–82 stakeholder engagement,24 83–86 clinical decision support,87–91 nudge,92–96 clinical champions,97–101 training102–106 and incentives79 107 were the component facets of interventions. Interventions were multifaceted in 79% (113/143) of studies and single faceted in 21% (30/143) of studies.…”

Section: Resultsmentioning

confidence: 99%

“…Of the included studies, 60% (12/20) of quantitative randomised,82 102 108 110 118 124–130 16.3% (20/123) of quantitative non-randomised,84 85 90 121 131–146 62.5% (5/8) of quantitative descriptive,61 62 64–66 100% (12/12) of qualitative48–57 and 25% (1/4) of mixed methods studies68 were assessed as being of higher quality. Among studies evaluating interventions, 21% (30/143) were of higher quality.…”

Section: Resultsmentioning

confidence: 99%

What works for and what hinders deimplementation of low-value care in emergency medicine practice? A scoping review

Gangathimmaiah,

Drever,

Evans

et al. 2023

BMJ Open

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ObjectivesLow-value care can harm patients and healthcare systems. Despite a decade of global endeavours, low value care has persisted. Identification of barriers and enablers is essential for effective deimplementation of low-value care. This scoping review is an evidence summary of barriers, enablers and features of effective interventions for deimplementation of low-value care in emergency medicine practice worldwide.DesignA mixed-methods scoping review was conducted using the Arksey and O’Malley framework.Data sourcesMedline, CINAHL, Embase, EMCare, Scopus and grey literature were searched from inception to 5 December 2022.Eligibility criteriaPrimary studies which employed qualitative, quantitative or mixed-methods approaches to explore deimplementation of low-value care in an EM setting and reported barriers, enablers or interventions were included. Reviews, protocols, perspectives, comments, opinions, editorials, letters to editors, news articles, books, chapters, policies, guidelines and animal studies were excluded. No language limits were applied.Data extraction and synthesisStudy selection, data collection and quality assessment were performed by two independent reviewers. Barriers, enablers and interventions were mapped to the domains of the Theoretical Domains Framework. The Mixed Methods Appraisal Tool was used for quality assessment.ResultsThe search yielded 167 studies. A majority were quantitative studies (90%, 150/167) that evaluated interventions (86%, 143/167). Limited provider abilities, diagnostic uncertainty, lack of provider insight, time constraints, fear of litigation, and patient expectations were the key barriers. Enablers included leadership commitment, provider engagement, provider training, performance feedback to providers and shared decision-making with patients. Interventions included one or more of the following facets: education, stakeholder engagement, audit and feedback, clinical decision support, nudge, clinical champions and training. Multifaceted interventions were more likely to be effective than single-faceted interventions. Effectiveness of multifaceted interventions was influenced by fidelity of the intervention facets. Use of behavioural change theories such as the Theoretical Domains Framework in the published studies appeared to enhance the effectiveness of interventions to deimplement low-value care.ConclusionHigh-fidelity, multifaceted interventions that incorporated education, stakeholder engagement, audit/feedback and clinical decision support, were administered daily and lasted longer than 1 year were most effective in achieving deimplementation of low-value care in emergency departments. This review contributes the best available evidence to date, but further rigorous, theory-informed, qualitative and mixed-methods studies are needed to supplement the growing body of evidence to effectively deimplement low-value care in emergency medicine practice.

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“…29 CDS systems with respect to imaging are based on the implementation of Appropriate Use Criteria collected and summarized from multiple societies and their respective guidelines, such as the American College of Radiology Appropriateness Criteria and the American College of Cardiology. 30,31 Their purpose is to inform the appropriateness of imaging and guide the appropriate protocol/modality. Given widespread concern for the inappropriate use of imaging, specifically the associated cost to the health-care system but also unnecessary exposure to ionizing radiation, 32,33 recent years have seen a growing trend in the implementation of clinical decision support systems both within and outside radiology.…”

Section: Clinical Decision Support Systemsmentioning

confidence: 99%

Emergency Radiology: Evolution, Current Status, and Future Directions

Basilico

Blanco

et al. 2022

Can Assoc Radiol J

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Emergency Radiology is a clinical practice and an academic discipline that has rapidly gained increasing global recognition among radiology and emergency/critical care departments and trauma services around the world. As with other subspecialties, Emergency Radiology practice has a unique scope and purpose and presents with its own unique challenges. There are several advantages of having a dedicated Emergency Radiology section, perhaps most important of which is the broad clinical skillset that Emergency Radiologists are known for. This multi-society paper, representing the views of Emergency Radiology societies in Canada and Europe, outlines several value-oriented contributions of Emergency Radiologists and briefly discusses the current state of Emergency Radiology as a subspecialty.

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Effect of Clinical Decision Support on Appropriateness of Advanced Imaging Use Among Physicians-in-Training

Cited by 18 publications

References 20 publications

Measuring appropriateness of diagnostic imaging: a scoping review

Measuring appropriateness of diagnostic imaging: a scoping review

What works for and what hinders deimplementation of low-value care in emergency medicine practice? A scoping review

Emergency Radiology: Evolution, Current Status, and Future Directions

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