Impact of a Clinical Decision Support System on CT Pulmonary Angiography Yield and Utilization in Hospitalized Patients

IF 4 3区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Journal of the American College of Radiology Pub Date : 2025-04-01 DOI:10.1016/j.jacr.2024.11.030

Amita Sharma MBBS , Mark Isabelle BA , Andetta Hunsaker MD , Sayon Dutta MD, MPH , David Lucier MD, MBA, MPH , Rachel P. Rosovsky MD, MPH , Sanjay Saini MD , Adam Landman MD , Ali S. Raja MD, MBA , Ramin Khorasani MD, MPH , Ronilda Lacson MD, PhD

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引用次数: 0

Abstract

Purpose

The aims of this study were to determine whether point-of-order clinical decision support (CDS) based on the Wells criteria improves CT pulmonary angiography (CTPA) yield and utilization in hospitalized patients in an enterprise-wide health system and to identify yield-related factors.

Methods

This retrospective, institutional review board–approved, cross-sectional study in an urban, multi-institution health system included hospitalized patients undergoing CTPA 12 months before and after CDS implementation (entire cohort). The χ² test was used to compare pulmonary embolism (PE) yield in patients in whom providers overrode versus followed CDS alerts after CDS implementation. It was also used to compare utilization and yield before- versus after the intervention. Univariate and multivariable regression analyses were performed on patient factors and post-CDS Wells scores to evaluate yield-related factors.

Results

For 2,429 inpatient CT pulmonary angiographic examinations after the intervention, CTPA yield was significantly higher when CDS recommendations were followed (18.3% [250 of 1,365]) compared with those overridden (14.2% [151 of 1,064]) (P < .01). For 5,372 CT pulmonary angiographic examinations in the entire cohort, there was no difference in PE yield before (448 of 2,943 [15.2%]) versus after (401 of 2,429 [16.5%]) CDS implementation (P = .20). However, in 340,146 admissions over the study period, a 7.4% relative decrease in CTPA utilization (from 17.5 to 16.2 CT pulmonary angiographic examinations per 1,000 admissions before and after CDS, respectively, P = .003) was observed.

Conclusions

When CDS recommendations were followed, the yield of CTPA was significantly higher than when clinicians overrode CDS alerts. In addition, point-of-order CDS to reduce unnecessary CTPA in hospitalized patients resulted in a significant decrease in CTPA utilization after CDS implementation, with a modest although nonsignificant increase in CTPA yield.

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临床决策支持系统对住院患者肺血管造影成像率和利用率的影响。

目的：确定基于Wells标准的点订单临床决策支持（CDS）是否能提高企业卫生系统住院患者CT肺血管造影（CTPA）的产出率和利用率，并确定产出率相关因素。方法：这项回顾性的经irb批准的横断面研究在一个城市、多机构的卫生系统中进行，包括在实施CDS前后12个月接受CTPA的住院患者（整个队列）。卡方检验用于比较提供者在实施CDS后无视CDS警报和遵循CDS警报的患者的PE率。它还用于比较干预前后的利用率和产量。对患者因素和cds后的Wells评分进行单变量和多变量回归分析，以评估产量相关因素。结果：干预后2429例住院CTPA患者中，遵循CDS建议的CTPA产出率（18.3%[250/1365]）明显高于不采纳CDS建议的CTPA产出率（14.2%[151/1064]）。讨论：遵循CDS建议的CTPA产出率显著高于不采纳CDS警报的CTPA产出率。此外，为了减少住院患者不必要的CTPA，使用点订单CDS导致实施CDS后CTPA利用率显著降低，CTPA产量略有增加，但不显著。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of the American College of Radiology RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING-

CiteScore

6.30

自引率

8.90%

发文量

312

审稿时长

34 days

期刊介绍： The official journal of the American College of Radiology, JACR informs its readers of timely, pertinent, and important topics affecting the practice of diagnostic radiologists, interventional radiologists, medical physicists, and radiation oncologists. In so doing, JACR improves their practices and helps optimize their role in the health care system. By providing a forum for informative, well-written articles on health policy, clinical practice, practice management, data science, and education, JACR engages readers in a dialogue that ultimately benefits patient care.