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Higher Imaging Yield When Clinical Decision Support Is Used.

Safiya Richardson1, Stuart Cohen1, Sundas Khan1

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Summary
This summary is machine-generated.

Clinical decision support (CDS) tools significantly increased the diagnostic yield of CT pulmonary angiography (CTPA) for pulmonary embolism evaluation. Using CDS was associated with a 38% higher imaging yield across all provider types.

Keywords:
Clinical decision support systemselectronic health recordhealth informaticspulmonary embolismquality improvement

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Area of Science:

  • Radiology
  • Medical Informatics
  • Emergency Medicine

Background:

  • CT pulmonary angiography (CTPA) use is increasing, but diagnostic yields are declining, raising concerns about unnecessary testing.
  • Clinical decision support (CDS) tools offer a potential solution to improve the efficiency and accuracy of diagnostic imaging.

Purpose of the Study:

  • To evaluate the association between CDS tool utilization and CTPA diagnostic yield for pulmonary embolism.
  • To control for selection bias in assessing the impact of CDS on imaging yields.

Main Methods:

  • A retrospective cohort study of 7,367 CTPAs performed between August 2015 and September 2018 in two tertiary care hospitals.
  • Propensity score matching was used to compare CTPA yield between providers who used the CDS tool and those who did not.
  • Yield was stratified by provider type (attending physicians, residents, physician assistants).

Main Results:

  • CTPA diagnostic yield was 11.99% in the CDS-use group versus 8.70% in the CDS-dismissal group (P < .001).
  • CDS use was associated with a 38% higher diagnostic yield overall.
  • Increased yields were observed for attending physicians (56.5%), residents (38.7%), and physician assistants (16.7%) using CDS.

Conclusions:

  • The use of CDS tools significantly enhances the diagnostic yield of CTPA for pulmonary embolism.
  • CDS tools demonstrate effectiveness across various provider types, improving the accuracy of diagnostic imaging.
  • Further research is warranted to optimize strategies for increasing provider adoption of CDS tools.