ArticleBMJ open quality2021
Quality improvement time-saving intervention to increase use of a clinical decision support tool to reduce low-value diagnostic imaging in a safety net health system.
Article in BMJ open quality, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT07717541 (Poetry Workshops to Enhance Patient Well-Being and Reduce Anxiety Levels), which is not on this map. Cited by 7 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Poetry Workshops to Enhance Patient Well-Being and Reduce Anxiety Levels
Who cites it
7 citing papers in PubMed, 12 citations in OpenAlex.
- Implementation of Electronic Clinical Decision Support for Radiology Referrals: The Role of Governance, Clinician Engagement and Education.Emergency medicine Australasia : EMA · 2026Article
- Impact of point-of-care clinical decision support on referrer behavior, imaging volume, patient radiation dose exposure, and sustainability.Insights into imaging · 2024Article
- What works for and what hinders deimplementation of low-value care in emergency medicine practice? A scoping review.BMJ open · 2023Article
- Assessing Serious Spinal Pathology Using Bayesian Network Decision Support: Development and Validation Study.JMIR formative research · 2023Article
- Choosing Wisely interventions to reduce antibiotic overuse in the safety net.The American journal of managed care · 2023Article
- Measuring appropriateness of diagnostic imaging: a scoping review.Insights into imaging · 2023Article
- Applying a knowledge translation framework for triaging low back pain and radicular pain at an emergency department: an iterative process within an uncontrolled before-and-after design.BMJ open quality · 2022Article
Corrections and comments
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Authors and funding
7 authors at 2 institutions in 1 country.
Funding
Abstract
importanceElectronic health record (EHR) clinical decision support (CDS) tools can provide evidence-based feedback at the point of care to reduce low-value imaging. Success of these tools has been limited partly due to lack of engagement by busy clinicians.
objectiveMeasure the impact of a time-saving quality improvement intervention to increase engagement with a CDS tool for low back pain imaging ordering. DESIGN, SETTING AND
participantsWe conducted a quasi-experimental difference-in-differences analysis at (BLINDED), examining back pain imaging orders from 29 May 2015 to 07 January 2016. The intervention site was (BLINDED) Emergency Medicine/Urgent Care Center (n=5736) and control sites included all other (BLINDED) hospitals and clinics (n=1621). In May 2015, the Department of Health Services installed a CDS tool that triggered a survey when clinicians ordered an imaging test, generating an 'appropriateness score' based on the American College of Radiology guidelines. Clinicians often bypassed the tool, resulting in 'unscored' tests.
interventionTo increase clinician engagement with the tool and decrease the rate of unscored imaging tests, a new policy was implemented at the intervention site on 15 August 2015. If clinicians completed the CDS survey and scored an appropriateness score >3, they could forego a previously mandatory telephone call for pre-imaging utilisation review with the radiology department. MAIN OUTCOMES AND MEASURES: We used EHR data to measure pre-post-intervention differences in: (1) percentage of unscored tests and (2) percentage of tests with high appropriateness scores (>7).
resultsPercentage of unscored tests decreased from 69.4% to 10.4% at the intervention site and from 50.6% to 34.8% at the control sites (between-group difference: -23.3%, p<0.001). Percentage of high scoring tests increased from 26.5% to 75.0% at the intervention site and from 17.2% to 22.7% at the control sites (between-group difference: 19%, p<0.001).
conclusionWorkflow time-saving interventions may increase physician engagement with CDS tools and have potential to improve practice patterns.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.