Clinical Decision Support (CDS) for Radiology Imaging

NCT02996045 | Completed

• 1 other identifier: JPAL-5002
• Study Type: interventional
• Target: 3,511
• Locations: 1 country
• Sites: 1

Brief Summary

The goal of the study is to determine whether clinical decision support (CDS) for radiology affects the number, type, or appropriateness of targeted high-cost radiology imaging orders (i.e. magnetic resonance (MR), computed tomography (CT), nuclear medicine (NM) and Positron Emission Tomography (PET) scans). The CDS will be delivered to physicians in the Aurora Health Care system. It will be delivered in Epic, an industry-standard electronic medical record software, through ACR Select, which is a leading decision support tool based on the American College of Radiology (ACR) Appropriateness Criteria (see http://www.acr.org/Quality-Safety/Appropriateness-Criteria). The ACR Select tool rates imaging orders on a scale of 1-9 with 1-3 labelled as 'usually not appropriate', 4-6 'May be appropriate', and 7-9 'usually appropriate'.

Conditions

CT, MR, NM, and PET Image Orders

Outcome Measures

Primary Outcomes (1)

• number of scans ordered that would be subject to the CDS best practice alert

  Scans where the CDS would be triggered based on the criteria listed in the intervention description

  first 365 days after CDS is turned on for the treatment group

Secondary Outcomes (3)

• Number of high-cost scans (CT, MR, NM and PET) ordered

  first 365 days after CDS is turned on for the treatment group

• Number of scans ordered that would be subject to the CDS best practice alert and that ACR Select rates 1-3 ("usually not appropriate")

  first 365 days after CDS is turned on for the treatment group

• Number of scans ordered that would be subject to the CDS best practice alert and that ACR Select rates 4-6 ("may be appropriate")

  first 365 days after CDS is turned on for the treatment group

Other Outcomes (1)

• Number of low-cost scans ordered

  first 365 days after CDS is turned on for the treatment group

Study Arms (2)

Treatment

EXPERIMENTAL

Clinical Decision Support (CDS)

Other: Clinical Decision Support (CDS)

Control

NO INTERVENTION

Will not receive Clinical Decision Support (CDS)

Interventions

Clinical Decision Support (CDS) OTHER

A best practices alert (BPA) pop-up screen providing CDS will appear at physician sign-off for all scans scored 1-6, and scans scored 7-8 for which an alternative scan scored 8-9 exists. This screen will show the appropriateness score of the original scan order, and will display up to 7 alternative scans that are scored \>4 and greater than or equal to the original score for the same indications and patient characteristics. It will also display a link to relevant ACR documentation relevant to the selected scan and indication.

Treatment

Eligibility Criteria

• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

• Medical provider actively employed at Aurora with a valid Epic log-in.
• Is a Medical Doctor (MD), Doctors of Osteopathic Medicine (DO), podiatrist (DPM), nurse practitioner (NP), physician assistant (PA), or certified nurse midwife (CNM)
• Has imaging order permissions at Aurora Health Care.
• Has at least one high- or low-cost imaging order in the year from November 1, 2015 to November 1, 2016 or is medical resident who joined Aurora since that time.

You may not qualify if:

• Opted out of the study prior to November 24, 2016

Sponsors & Collaborators

• Abdul Latif Jameel Poverty Action Lab: lead
• Wake Forest University Health Sciences: collaborator
• Laura and John Arnold Foundation: collaborator
• Massachusetts Institute of Technology: collaborator

Study Sites (1)

Aurora Health Care

Milwaukee, Wisconsin, 53204, United States

Location

Related Publications (11)

• Callaghan BC, Kerber KA, Pace RJ, Skolarus LE, Burke JF. Headaches and neuroimaging: high utilization and costs despite guidelines. JAMA Intern Med. 2014 May;174(5):819-21. doi: 10.1001/jamainternmed.2014.173. No abstract available.

  PMID: 24638246 BACKGROUND

• Georgiou A, Prgomet M, Markewycz A, Adams E, Westbrook JI. The impact of computerized provider order entry systems on medical-imaging services: a systematic review. J Am Med Inform Assoc. 2011 May 1;18(3):335-40. doi: 10.1136/amiajnl-2010-000043. Epub 2011 Mar 8.

  PMID: 21385821 BACKGROUND

• Shreibati JB, Baker LC. The relationship between low back magnetic resonance imaging, surgery, and spending: impact of physician self-referral status. Health Serv Res. 2011 Oct;46(5):1362-81. doi: 10.1111/j.1475-6773.2011.01265.x. Epub 2011 Apr 21.

  PMID: 21517834 BACKGROUND

• Brenner DJ, Hall EJ. Computed tomography--an increasing source of radiation exposure. N Engl J Med. 2007 Nov 29;357(22):2277-84. doi: 10.1056/NEJMra072149. No abstract available.

  PMID: 18046031 BACKGROUND

• Centers for Medicare & Medicaid Services, 2013. National Health Expenditures 2013 Highlights. Centers for Medicare & Medicaid Services.

  BACKGROUND

• Sherman, D., 2012. Stemming the tide of overtreatment in U.S. healthcare. Reuters. Feb 16, 2012.

  BACKGROUND

• U.S. Government Accountability Office, 2008. Medicare Part B Imaging Services: Rapid Spending Growth and Shift to Physician Offices Indicate Need for CMS to Consider Additional Management Practices [WWW Document]. URL http://www.gao.gov/products/GAO-08-452 (accessed 2.23.15).

  BACKGROUND

• Consumer Reports, 2015. Surprising Dangers of CT Scans and X-rays - Consumer Reports [WWW Document]. URL http://www.consumerreports.org/cro/magazine/2015/01/the-surprising-dangers-of-ct-sans-and-x-rays/index.htm (accessed 2.25.15).

  BACKGROUND

• Dehn, T.G., O'Connell, B., Hall, R.N., Moulton, T., 2000. Appropriateness of imaging examinations: current state and future approaches. Imaging Econ 13, 18-26.

  BACKGROUND

• Medicare Payment Advisory Commission, 2014. Health Care Spending and the Medicare Program. MedPAC.

  BACKGROUND

• Pitts, J., 2014. The Protecting Access to Medicare Act of 2014.

  BACKGROUND

Study Officials

• Joseph Doyle, PhD

  Massachusetts Institute of Technology

  PRINCIPAL INVESTIGATOR

• Amy Finkelstein, PhD

  Massachusetts Institute of Technology

  PRINCIPAL INVESTIGATOR

• Sarah Reimer, MD

  Wake Forest University Health Sciences

  PRINCIPAL INVESTIGATOR

• Laura Feeney, MA

  Massachusetts Institute of Technology

  PRINCIPAL INVESTIGATOR

• Sarah Abraham

  Massachusetts Institute of Technology

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: December 15, 2016
• First Posted: December 19, 2016
• Study Start: December 15, 2016
• Primary Completion: December 1, 2018
• Study Completion: December 1, 2018
• Last Updated: July 15, 2020

Record last verified: 2020-07

Data Sharing

• IPD Sharing: Will not share

Locations

US (1)