Evaluation of a Clinical Decision Support System for Imaging Requests: A Cluster Randomized Clinical Trial

Area of Science:

• Medical Imaging
• Health Informatics
• Clinical Decision Support

Background:

• Medical imaging is widely used, making interventions to improve appropriateness essential for resource optimization and patient outcomes.
• Evaluating the impact of clinical decision support systems (CDSS) on physician ordering behavior is crucial.

Purpose of the Study:

• To assess the effectiveness of the European Society of Radiology iGuide CDSS in improving the appropriateness of medical imaging requests by physicians.
• To evaluate the impact of CDSS implementation on physician ordering behavior in academic hospital settings.

Main Methods:

• A cluster randomized clinical trial was conducted across 26 departments in 3 German university hospitals.
• The study used a before-and-after design, comparing 13 intervention departments with a CDSS to 13 control departments over 2.5 years.
• A difference-in-differences analysis assessed changes in the proportion of inappropriate imaging requests.

Main Results:

• A total of 65,764 imaging requests were analyzed.
• The intervention group showed a mean reduction of -0.5% in inappropriate requests, while the control group showed -1.8%.
• The difference-in-differences analysis revealed no statistically significant reduction in inappropriate imaging requests (P = .69).

Conclusions:

• The implemented clinical decision support system (CDSS) did not lead to a statistically significant reduction in inappropriate medical imaging requests.
• The findings suggest that this specific CDSS may not be effective in altering physician ordering behavior in academic hospital settings.
• Further research may be needed to explore alternative strategies for improving medical imaging appropriateness.