Joint Design with Providers of Clinical Decision Support for Value-Based Advanced Shoulder Imaging

Area of Science:

• Radiology
• Health Informatics
• Clinical Decision Support

Background:

• Inappropriate advanced imaging orders strain healthcare resources.
• The Appropriate Use Criteria Program was established to address this issue.
• Optimizing diagnostic imaging for shoulder pain is crucial.

Purpose of the Study:

• To determine if co-designing clinical decision support (CDS) with referring providers reduces barriers to adoption.
• To facilitate more appropriate shoulder ultrasound (US) over magnetic resonance imaging (MRI) in diagnosing Veteran shoulder pain.
• To assess the impact of co-designed CDS on imaging utilization and appropriateness.

Main Methods:

• A theory-driven, convergent parallel mixed-methods approach was used.
• Provider interviews identified reasons for MRI preference and barriers to US ordering.
• Co-designed CDS was implemented, and its impact on imaging orders was monitored.
• Ordering data was analyzed using generalized estimating equations and mixed effects analysis of variance.

Main Results:

• Co-designed CDS increased shoulder ultrasound (US) utilization from 17% to 50% of all orders.
• Appropriate imaging order rates more than doubled, increasing from 31% to 67%.
• Interviews confirmed generalist providers' need for assistance in ordering advanced imaging appropriately.

Conclusions:

• Collaborative co-design of CDS with providers effectively reduced barriers to appropriate shoulder imaging.
• The study demonstrated a successful transition from MRI to US for shoulder pain diagnosis, promoting evidence-based practice.
• This co-design approach offers a model for developing and implementing other CDS interventions.