The use of decision support to measure documented adherence to a national imaging quality measure

doi:10.1016/j.acra.2013.10.017

. 2014 Mar;21(3):378-83.

doi: 10.1016/j.acra.2013.10.017.

The use of decision support to measure documented adherence to a national imaging quality measure

Ali S Raja¹, Anurag Gupta², Ivan K Ip³, Angela M Mills⁴, Ramin Khorasani⁵

Affiliations

¹ Center for Evidence-Based Imaging, Brigham and Women's Hospital, 20 Kent St 2nd Floor, Brookline, MA 02445; Department of Radiology, Brigham and Women's Hospital, Brookline, MA; Department of Emergency Medicine, Brigham and Women's Hospital, Brookline, MA; Harvard Medical School, Boston, MA. Electronic address: asraja@partners.org.
² Center for Evidence-Based Imaging, Brigham and Women's Hospital, 20 Kent St 2nd Floor, Brookline, MA 02445; Department of Radiology, Brigham and Women's Hospital, Brookline, MA; Department of Emergency Medicine, Brigham and Women's Hospital, Brookline, MA; Harvard Medical School, Boston, MA.
³ Center for Evidence-Based Imaging, Brigham and Women's Hospital, 20 Kent St 2nd Floor, Brookline, MA 02445; Department of Radiology, Brigham and Women's Hospital, Brookline, MA; Department of Medicine, Brigham and Women's Hospital, Brookline, MA; Harvard Medical School, Boston, MA.
⁴ Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA.
⁵ Center for Evidence-Based Imaging, Brigham and Women's Hospital, 20 Kent St 2nd Floor, Brookline, MA 02445; Department of Radiology, Brigham and Women's Hospital, Brookline, MA; Harvard Medical School, Boston, MA.

PMID: 24507424
PMCID: PMC4112090
DOI: 10.1016/j.acra.2013.10.017

The use of decision support to measure documented adherence to a national imaging quality measure

Ali S Raja et al. Acad Radiol. 2014 Mar.

. 2014 Mar;21(3):378-83.

doi: 10.1016/j.acra.2013.10.017.

Authors

Ali S Raja¹, Anurag Gupta², Ivan K Ip³, Angela M Mills⁴, Ramin Khorasani⁵

Affiliations

¹ Center for Evidence-Based Imaging, Brigham and Women's Hospital, 20 Kent St 2nd Floor, Brookline, MA 02445; Department of Radiology, Brigham and Women's Hospital, Brookline, MA; Department of Emergency Medicine, Brigham and Women's Hospital, Brookline, MA; Harvard Medical School, Boston, MA. Electronic address: asraja@partners.org.
² Center for Evidence-Based Imaging, Brigham and Women's Hospital, 20 Kent St 2nd Floor, Brookline, MA 02445; Department of Radiology, Brigham and Women's Hospital, Brookline, MA; Department of Emergency Medicine, Brigham and Women's Hospital, Brookline, MA; Harvard Medical School, Boston, MA.
³ Center for Evidence-Based Imaging, Brigham and Women's Hospital, 20 Kent St 2nd Floor, Brookline, MA 02445; Department of Radiology, Brigham and Women's Hospital, Brookline, MA; Department of Medicine, Brigham and Women's Hospital, Brookline, MA; Harvard Medical School, Boston, MA.
⁴ Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA.
⁵ Center for Evidence-Based Imaging, Brigham and Women's Hospital, 20 Kent St 2nd Floor, Brookline, MA 02445; Department of Radiology, Brigham and Women's Hospital, Brookline, MA; Harvard Medical School, Boston, MA.

PMID: 24507424
PMCID: PMC4112090
DOI: 10.1016/j.acra.2013.10.017

Abstract

Rationale and objectives: Present methods for measuring adherence to national imaging quality measures often require a resource-intensive chart review. Computerized decision support systems may allow for automated capture of these data. We sought to determine the feasibility of measuring adherence to a national quality measure (NQM) regarding computed tomography pulmonary angiograms (CTPAs) for pulmonary embolism using measure-targeted clinical decision support and whether the associated increased burden of data captured required by this system would affect the use and yield of CTs.

Materials and methods: This institutional review board-approved prospective cohort study enrolled patients from September 1, 2009, through November 30, 2011, in the emergency department (ED) of a 776-bed quaternary-care adults-only academic medical center. Our intervention consisted of an NQM-targeted clinical decision support tool for CTPAs, which required mandatory input of the Wells criteria and serum D-dimer level. The primary outcome was the documented adherence to the quality measure prior and subsequent to the intervention, and the secondary outcomes were the use and yield of CTPAs.

Results: A total of 1209 patients with suspected PE (2.0% of 58,795 ED visits) were imaged by CTPA during the 12-month control period, and 1212 patients were imaged in the 12 months after the quarter during which the intervention was implemented (2.0% of 59,478 ED visits, P = .84). Documented baseline adherence to the NQM was 56.9% based on a structured review of the provider notes. After implementation, documented adherence increased to 75.6% (P < .01). CTPA yield remained unchanged and was 10.4% during the control period and 10.1% after the intervention (P = .88).

Conclusions: Implementation of a clinical decision support tool significantly improved documented adherence to an NQM, enabling automated measurement of provider adherence to evidence without the need for resource-intensive chart review. It did not adversely affect the use or yield of CTPAs.

Keywords: Quality measures; computerized decision support; emergency department; imaging.

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Figures

**Figure 1**
First Generation Clinical Decision Support

**Figure 2**
National Quality Measure-Targeted Clinical Decision Support

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References

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1. Lamb GC, Smith MA, Weeks WB, Queram C. Publicly Reported Quality-Of-Care Measures Influenced Wisconsin Physician Groups To Improve Performance. Health Aff. 2013 Mar 1;32(3):536–43. - PMC - PubMed
1. Spinks TE, Walters R, Feeley TW, Albright HW, Jordan VS, Bingham J, et al. Improving Cancer Care Through Public Reporting Of Meaningful Quality Measures. Health Aff. 2011 Apr 1;30(4):664–72. - PubMed
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[1] Iglehart JK. The new era of medical imaging--progress and pitfalls. N Engl J Med. 2006 Jun 29;354(26):2822–8. - PubMed

[2] Iglehart JK. The new era of medical imaging--progress and pitfalls. N Engl J Med. 2006 Jun 29;354(26):2822–8. - PubMed

[3] Lamb GC, Smith MA, Weeks WB, Queram C. Publicly Reported Quality-Of-Care Measures Influenced Wisconsin Physician Groups To Improve Performance. Health Aff. 2013 Mar 1;32(3):536–43. - PMC - PubMed

[4] Lamb GC, Smith MA, Weeks WB, Queram C. Publicly Reported Quality-Of-Care Measures Influenced Wisconsin Physician Groups To Improve Performance. Health Aff. 2013 Mar 1;32(3):536–43. - PMC - PubMed

[5] Spinks TE, Walters R, Feeley TW, Albright HW, Jordan VS, Bingham J, et al. Improving Cancer Care Through Public Reporting Of Meaningful Quality Measures. Health Aff. 2011 Apr 1;30(4):664–72. - PubMed

[6] Spinks TE, Walters R, Feeley TW, Albright HW, Jordan VS, Bingham J, et al. Improving Cancer Care Through Public Reporting Of Meaningful Quality Measures. Health Aff. 2011 Apr 1;30(4):664–72. - PubMed

[7] Broder J, Warshauer DM. Increasing utilization of computed tomography in the adult emergency department, 2000–2005. Emerg Radiol. 2006 Oct;13(1):25–30. - PubMed

[8] Broder J, Warshauer DM. Increasing utilization of computed tomography in the adult emergency department, 2000–2005. Emerg Radiol. 2006 Oct;13(1):25–30. - PubMed

[9] Lee J, Kirschner J, Pawa S, Wiener DE, Newman DH, Shah K. Computed Tomography Use in the Adult Emergency Department of an Academic Urban Hospital From 2001 to 2007. Annals of Emergency Medicine [Internet] 2010 Jul; [cited 2010 Oct 12]; Available from: http://www.annemergmed.com/article/S0196-0644(10)00499-3/abstract. - PubMed

[10] Lee J, Kirschner J, Pawa S, Wiener DE, Newman DH, Shah K. Computed Tomography Use in the Adult Emergency Department of an Academic Urban Hospital From 2001 to 2007. Annals of Emergency Medicine [Internet] 2010 Jul; [cited 2010 Oct 12]; Available from: http://www.annemergmed.com/article/S0196-0644(10)00499-3/abstract. - PubMed

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The use of decision support to measure documented adherence to a national imaging quality measure

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The use of decision support to measure documented adherence to a national imaging quality measure

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