Impact of Health It and Clinical Decision Support on the Use of Ct Pulmonary Angiography in Hospitalized Patients

1Brigham and Women’s Hospital, Boston, MA

Meeting: Hospital Medicine 2014, March 24-27, Las Vegas, Nev.

Abstract number: 238

Background:

Reducing unnecessary high‐cost imaging has received increasing emphasis. With substantial financial investments in the Health Information Technology for Economic and Clinical Health provisions of the American Recovery and Reinvestment Act, there are great expectations for health information technology (HIT) as a potential solution. Yet, the impact of HIT on use of imaging remains largely unclear. In the case of patients suspected of pulmonary embolism (PE), despite the existence of high‐quality clinical decision rules to help identify low‐utility studies, the adoption of such evidence into clinical practice remains widely variable.

Purpose:

To examine the impact of clinical decision support (CDS), incorporated into computerized physician order entry (CPOE), on the use of CT pulmonary angiography (CTPA) in hospitalized patient suspected of PE.

Description:

This HIPAA‐compliant cohort study was performed at a tertiary‐care, 793‐bed, urban academic hospital. Study cohort included all adult hospitalized patients during the study period. After a 31‐month baseline observation period, a CDS based on Well’s Criteria was implemented. Based on the clinical history input via CPOE, low utility CTPA orders triggered a CDS alert to ordering provider, suggesting that the study may not be warranted based on existing literature. The clinician may cancel the request, or ignore the CDS and proceed with the order. Our primary outcome measure was the monthly utilization of CTPA, defined as number of CTPAs per 1000 admissions. Secondary outcome was the yield of CTPA (% of CTPAs positive for acute PE). Linear trend analysis was used to assess for impact and trend differences in CTPA utilization and yield pre‐ and post‐CDS. Student t‐tests were used to assess for pre‐/post‐ differences in CTPA use and chi‐square was used for yield.

We found that the implementation of CDS was associated with an immediate 12.3% decrease in the monthly CTPA utilization rate (26.0 CTPAs per 1000 admissions pre‐CDS compared to 22.8 CTPAs per 1000 admissions post‐CDS, p<0.001). The decrease occurred within 1 month of CDS implementation, and sustained for the subsequent 32 months. The mean monthly CTPA yield did not change significantly between the pre‐ and post‐intervention periods (10.4% pre‐ vs 12.1% post, p=0.65).

Conclusions:

Implementing an evidence‐based clinical decision support may produce an immediate and sustained improvement in reducing potentially inappropriate imaging in patients suspected of PE.

To cite this abstract:

Ip I, Dunne R, Abbett S, Gershanik E, Raja A, Hunsaker A, Khorasani R. Impact of Health It and Clinical Decision Support on the Use of Ct Pulmonary Angiography in Hospitalized Patients. Abstract published at Hospital Medicine 2014, March 24-27, Las Vegas, Nev. Abstract 238. Journal of Hospital Medicine. 2014; 9 (suppl 2). https://www.shmabstracts.com/abstract/impact-of-health-it-and-clinical-decision-support-on-the-use-of-ct-pulmonary-angiography-in-hospitalized-patients/. Accessed March 28, 2020.

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