Medical Imaging Decision And Support (MIDAS): Study protocol for a multi-centre cluster randomized trial evaluating...

Area of Science:

• Radiology and Medical Imaging
• Health Informatics
• Clinical Decision Support

Background:

• Medical imaging is crucial but often overused, leading to adverse patient outcomes and increased healthcare costs.
• Clinical Decision Support Systems (CDSSs) aim to optimize imaging test selection by referring physicians.
• Overutilization of diagnostic imaging necessitates strategies to improve appropriate use.

Purpose of the Study:

• To evaluate the impact of a CDSS (ESR iGuide) on appropriate medical imaging use.
• To compare the effectiveness of a CDSS with active decision support versus no active support.
• To assess the influence of CDSS implementation on physician ordering behavior for imaging tests.

Main Methods:

• A multi-center cluster-randomized trial with a before-after-revert design across eight university hospital departments.
• Implementation of a CDSS (ESR iGuide) with physicians initially blinded to appropriateness scores.
• Randomization of half the clusters to active decision support, providing feedback on imaging request appropriateness.

Main Results:

• The primary outcome measured is the proportion of inappropriate diagnostic imaging exams requested.
• Secondary outcomes include the total number of imaging exams, radiation exposure, and associated medical costs.
• The study protocol is registered under NCT05490290 and has received ethical approval.

Conclusions:

• Active decision support within a CDSS has the potential to significantly reduce inappropriate medical imaging orders.
• Optimizing imaging test selection through CDSS can lead to improved patient outcomes and cost savings.
• Further analysis of the collected data will elucidate the educational effect of active decision support removal.