Effect of Clinical Decision Support-Generated Report Cards Versus Real-Time Alerts on Primary Care Provider Guideline Adherence for Low Back Pain Outpatient Lumbar Spine MRI Orders.
AJR Am J Roentgenol
; 212(2): 386-394, 2019 02.
Article
em En
| MEDLINE
| ID: mdl-30476451
ABSTRACT
OBJECTIVE:
The purpose of this study is to determine whether the type of feedback on evidence-based guideline adherence influences adult primary care provider (PCP) lumbar spine (LS) MRI orders for low back pain (LBP). MATERIALS ANDMETHODS:
Four types of guideline adherence feedback were tested on eight tertiary health care system outpatient PCP practices no feedback during baseline (March 1, 2012-October 4, 2012), randomization by practice to either clinical decision support (CDS)-generated report cards comparing providers to peers only or real-time CDS alerts at order entry during intervention 1 (February 6, 2013-December 31, 2013), and both feedback types for all practices during intervention 2 (January 14, 2014-June 20, 2014, and September 4, 2014-January 21, 2015). International Classification of Disease codes identified LBP visits (excluding Medicare fee-for-service). The primary outcome of the likelihood of LS MRI order being made on the day of or 1-30 days after the outpatient LBP visit was adjusted by feedback type (none, report cards only, real-time alerts only, or both); patient age, sex, race, and insurance status; and provider sex and experience.RESULTS:
Half of PCPs (54/108) remained for all three periods, conducting 9394 of 107,938 (8.7%) outpatient LBP visits. The proportion of LBP visits increased over the course of the study (p = 0.0001). In multilevel hierarchic regression, report cards resulted in a lower likelihood of LS MRI orders made the day of and 1-30 days after the visit versus baseline 38% (p = 0.009) and 37% (p = 0.006) for report cards alone, and 27% (p = 0.020) and 27% (p = 0.016) with alerts, respectively. Real-time alerts alone did not affect MRI orders made the day of (p = 0.585) or 1-30 days after (p = 0.650) the visit. No patient or provider variables were associated with LS MRI orders being generated on the day of or 1-30 days after the LBP visit.CONCLUSION:
CDS-generated evidence-based report cards can substantially reduce outpatient PCP LS MRI orders on the day of and 1-30 days after the LBP visit. Real-time CDS alerts do not.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Atenção Primária à Saúde
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Coluna Vertebral
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Padrões de Prática Médica
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Imageamento por Ressonância Magnética
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Dor Lombar
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Fidelidade a Diretrizes
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Sistemas de Apoio a Decisões Clínicas
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Prescrições
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Assistência Ambulatorial
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Tomada de Decisão Clínica
Tipo de estudo:
Clinical_trials
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Guideline
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Prognostic_studies
Limite:
Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
AJR Am J Roentgenol
Ano de publicação:
2019
Tipo de documento:
Article