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Assessing the challenges of using clinical decision support tools for MRI and CT

por Lauren Dubinsky, Senior Reporter | June 02, 2015
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Clinical decision support (CDS) tools that assist physicians in determining if MRI and CT scans should be performed may help reduce the number of unnecessary tests, but implementing the tools have proven to be a challenge, according to a new RAND Corporation study.

CDS tools are computer-based programs that analyze a patient’s characteristics and appropriateness criteria to recommend a treatment. The Protecting Access to Medicare Act of 2014 states that beginning in 2017, CDS tools must be used when ordering advanced diagnostic imaging in the Medicare program.

From October 2011 to November 2013, the researchers studied 3,340 participating clinicians who used CDS tools to select 117,348 MRI, CT and nuclear medicine procedures. The organizations that participated in the study spanned eight states and among them were three academic medical centers, two integrated delivery systems and a couple of independent practices.
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During the six-month baseline period, the CDS tools tracked whether orders were linked with appropriateness criteria, but did not provide the clinicians with feedback on the appropriateness of the orders. For the 18-month intervention period, the CDS tools provided feedback to the clinicians on whether the order was linked to appropriateness criteria and if so, the appropriateness rating and any recommendations for alternative orders.

The researchers found that there was a small increase in the amount of orders rated appropriate between the baseline and intervention period, which means that fewer patients were exposed to clinically inappropriate and potentially dangerous tests.

However, the CDS tools were not able to match most of the orders to appropriateness criteria either because there were no appropriateness criteria available for certain tests or because the tool was not able to find matching criteria.

The researchers believe that these findings suggest that CDS efforts should be focused on tools that help clinicians perform their work more efficiently and effectively. In addition, a more comprehensive set of evidence-based guidelines that spans a greater amount of advanced imaging orders for Medicare patients is needed.

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