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A Cognitive Fusion-guided Prostate Biopsy Using Multiparametric Magnetic Resonance Imaging and Transrectal Ultrasound
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A Clinical Reminder Order Check Intervention to Improve Guideline-concordant Imaging Practices for Men With Prostate
Shannon E Ciprut1, Matthew D Kelly1, Dawn Walter1
1VA New York Harbor Healthcare System, New York, NY; Department of Urology, New York University, New York, NY; Department of Population Health, New York University, New York, NY.
Urology
|July 30, 2020
Summary
A Clinical Reminder Order Check (CROC) improved guideline-concordant imaging for low-risk prostate cancer patients. This real-time alert system helped reduce inappropriate imaging rates in Veterans.
Area of Science:
- Urology
- Health Informatics
- Health Services Research
Background:
- Inappropriate prostate cancer imaging contributes to healthcare costs and patient burden.
- National Comprehensive Cancer Network (NCCN) guidelines exist to promote appropriate care for low-risk prostate cancer.
Purpose of the Study:
- To assess the impact of a Clinical Reminder Order Check (CROC) on inappropriate prostate cancer imaging rates.
- To evaluate the effectiveness of a real-time provider alert system in promoting guideline-concordant care.
Main Methods:
- Implementation of a CROC system at the VA New York Harbor Healthcare System (April 2015 - November 2017).
- Analysis of VA administrative claims data to compare imaging rates before and after CROC implementation.
- Qualitative analysis of provider overrides to understand decision-making processes.
Main Results:
- Guideline-concordant care increased from 57% (117/205) pre-CROC to 73% (61/83) post-CROC for low-risk prostate cancer patients.
- The CROC intervention was associated with improved adherence to imaging guidelines.
Conclusions:
- Computerized Patient Record System-based CROC interventions show promise in improving imaging practices.
- This system may help reduce unnecessary procedures and optimize care for Veterans with low-risk prostate cancer.
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