Clinical decision support for high-cost imaging: A randomized clinical trial

Area of Science:

• Health economics
• Medical informatics
• Radiology

Background:

• High-cost imaging utilization raises concerns regarding patient safety and escalating healthcare expenditures.
• Potentially inappropriate imaging orders contribute significantly to these costs.
• The Centers for Medicare and Medicaid Services (CMS) is implementing a mandate for Clinical Decision Support (CDS) integration with high-cost imaging orders.

Purpose of the Study:

• To evaluate the impact of Clinical Decision Support (CDS) on healthcare provider ordering behaviors for high-cost imaging.
• To assess whether CDS influences the appropriateness of advanced imaging orders.
• To provide evidence on the effectiveness of CDS in response to the impending CMS mandate.

Main Methods:

• A randomized trial involving 3,511 healthcare providers at Aurora Health Care.
• Implementation of CDS software providing best practice alerts for targeted imaging orders.
• Analysis of changes in provider ordering patterns for high-cost, low-cost, and targeted imaging scans.

Main Results:

• CDS implementation led to a statistically significant 6% reduction in targeted (potentially inappropriate) imaging orders.
• No statistically significant changes were observed in the total number of high-cost or low-cost imaging scans ordered.
• The study indicates a modest improvement in the appropriateness of high-cost imaging orders attributable to CDS.

Conclusions:

• Clinical Decision Support (CDS) tools can effectively decrease the ordering of targeted, potentially inappropriate high-cost imaging.
• While overall high-cost scan volumes remained unchanged, CDS shows promise in enhancing imaging appropriateness.
• The findings support the anticipated positive impact of the CMS mandate on judicious use of advanced imaging services.