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The objective of our study was to evaluate whether the use of a clinical decision support (CDS) tool improved the appropriateness scores of orders for advanced imaging in clinical practice. We used a stepped-wedge, cluster randomized clinical trial to evaluate the effectiveness of a CDS tool in an integrated health care system. Clinicians entered structured indications for each CT and MRI order, and the indications were electronically scored against appropriateness criteria to assign an appropriateness score. We compared the proportion of orders with adjusted appropriateness scores of 7 or greater (on a 1-9 scale) before and after activation of best practice alerts (BPAs) triggered for orders with low or marginal appropriateness scores. Secondary outcomes included the rate per month of orders for advanced imaging and the proportion of orders for which the radiology department requested changes. Between October 2015 and February 2016, 941 clinicians ordered 22,279 CT or MRI studies that met eligibility criteria. Before activation of the BPA, the mean proportion of appropriate orders (adjusted for time and clinic effect) was 77.0% (95% CI, 75.5-78.4%), which increased to 80.1% (95% CI, 78.7-81.5%) after activation ( = 0.001). There was no significant change in the rate of orders per month for advanced imaging. The proportion of order changes requested by the radiology department decreased from 5.7% (95% CI, 5.6-5.9%) before CDS implementation to 5.3% (95% CI, 5.1-5.5%) after CDS implementation ( < 0.001). Using an evidence-based CDS tool in clinical practice was associated with a modest but significant improvement in the appropriateness scores of advanced imaging orders.
This article was published in the following journal.
Name: AJR. American journal of roentgenology
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A cluster randomised study in the primary care setting to evaluate a electronic clinical decision tool for stroke prophylaxis in patients with atrial fibrillation.
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Works about randomized clinical trials that compare interventions in clinical settings and which look at a range of effectiveness outcomes and impacts.
Computer-based information systems used to integrate clinical and patient information and provide support for decision-making in patient care.
Work consisting of a clinical trial involving one or more test treatments, at least one control treatment, specified outcome measures for evaluating the studied intervention, and a bias-free method for assigning patients to the test treatment. The treatment may be drugs, devices, or procedures studied for diagnostic, therapeutic, or prophylactic effectiveness. Control measures include placebos, active medicine, no-treatment, dosage forms and regimens, historical comparisons, etc. When randomization using mathematical techniques, such as the use of a random numbers table, is employed to assign patients to test or control treatments, the trial is characterized as a RANDOMIZED CONTROLLED TRIAL.
Work consisting of a clinical trial that involves at least one test treatment and one control treatment, concurrent enrollment and follow-up of the test- and control-treated groups, and in which the treatments to be administered are selected by a random process, such as the use of a random-numbers table.
Clinical study in which a prospectively planned opportunity is included to modify trial designs and hypotheses based on analysis of data from subjects in the study.
Clinical Approvals Clinical Trials Drug Approvals Drug Delivery Drug Discovery Generics Drugs Prescription Drugs In the fields of medicine, biotechnology and pharmacology, drug discovery is the process by which drugs are dis...
In a clinical trial or interventional study, participants receive specific interventions according to the research plan or protocol created by the investigators. These interventions may be medical products, such as drugs or devices; procedures; or change...
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