Quality improvement time-saving intervention to increase use of a clinical decision support tool to reduce low-value diagnostic imaging in a safety net health system.

Lee B, Mafi J, Patel MK, Sorensen A, Vangala S, Wei E, Sarkisian C. Quality improvement time-saving intervention to increase use of a clinical decision support tool to reduce low-value diagnostic imaging in a safety net health system. BMJ open quality. 2021 Feb 1; 10(1).

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Abstract:

IMPORTANCE: Electronic health record (EHR) clinical decision support (CDS) tools can provide evidence-based feedback at the point of care to reduce low-value imaging. Success of these tools has been limited partly due to lack of engagement by busy clinicians. OBJECTIVE: Measure the impact of a time-saving quality improvement intervention to increase engagement with a CDS tool for low back pain imaging ordering. DESIGN, SETTING AND PARTICIPANTS: We conducted a quasi-experimental difference-in-differences analysis at (BLINDED), examining back pain imaging orders from 29 May 2015 to 07 January 2016. The intervention site was (BLINDED) Emergency Medicine/Urgent Care Center (n = 5736) and control sites included all other (BLINDED) hospitals and clinics (n = 1621). In May 2015, the Department of Health Services installed a CDS tool that triggered a survey when clinicians ordered an imaging test, generating an ''appropriateness score'' based on the American College of Radiology guidelines. Clinicians often bypassed the tool, resulting in ''unscored'' tests. INTERVENTION: To increase clinician engagement with the tool and decrease the rate of unscored imaging tests, a new policy was implemented at the intervention site on 15 August 2015. If clinicians completed the CDS survey and scored an appropriateness score > 3, they could forego a previously mandatory telephone call for pre-imaging utilisation review with the radiology department. MAIN OUTCOMES AND MEASURES: We used EHR data to measure pre-post-intervention differences in: (1) percentage of unscored tests and (2) percentage of tests with high appropriateness scores ( > 7). RESULTS: Percentage of unscored tests decreased from 69.4% to 10.4% at the intervention site and from 50.6% to 34.8% at the control sites (between-group difference: -23.3%, p < 0.001). Percentage of high scoring tests increased from 26.5% to 75.0% at the intervention site and from 17.2% to 22.7% at the control sites (between-group difference: 19%, p < 0.001). CONCLUSION: Workflow time-saving interventions may increase physician engagement with CDS tools and have potential to improve practice patterns.