The Use of Decision Support to Measure Adherence to a National Imaging Quality Measure

Rationale and Objectives—Current methods for measuring adherence to national imaging quality measures often requires resource-intensive chart review. Computerized decision support systems may allow for automated capture of these data. We sought to determine the feasibility of measuring adherence to a national quality measure regarding CT pulmonary angiograms for pulmonary embolism (PE) using measure-targeted clinical decision support, as well as whether the associated increased burden of data capture required by this system would affect the use and yield of CTs. Materials and Methods—This IRB-approved prospective cohort study enrolled patients from 9/1/09 to 11/30/11 in the emergency department of a 776-bed quaternary care adult-only academic medical center. Our intervention consisted of a national quality measure-targeted clinical decision support tool for CT pulmonary angiograms, which required mandatory input of the Wells criteria and serum D-dimer level. The primary outcome was the documented adherence to the quality measure prior and subsequent to the intervention, and the secondary outcomes were the use and yield of CT pulmonary angiograms. Results—A total of 1,209 patients with suspected PE (2.0% of 58,795 ED visits) were imaged by CTPA during the 12-month control period, and 1,212 patients were imaged in the 12 months © 2013 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved. Address all correspondence and requests for reprints to: Ali S. Raja, MD, MBA, MPH, Center for Evidence-Based Imaging, Brigham and Women’s Hospital, 20 Kent St. 2nd Floor, Brookline MA 02445, asraja@partners.org, Phone# 617-525-8231, Fax: 617-525-7575. All authors had access to the data and a role in writing the manuscript Financial Disclosure: RK is named on a patent held by Brigham and Women’s Hospital and licensed to Medicalis. BWH and the inventors, including Dr. Khorasani, have financial interests, including equity and royalties, in Medicalis and some of its products. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access Author Manuscript Acad Radiol. Author manuscript; available in PMC 2015 March 01. Published in final edited form as: Acad Radiol. 2014 March ; 21(3): 378–383. doi:10.1016/j.acra. 2013.10.017. N IH -P A A uhor M anscript N IH -P A A uhor M anscript N IH -P A A uhor M anscript following the quarter during which the intervention was implemented (2.0% of 59,478 ED visits, p=0.84). Documented baseline adherence to the national quality measure was 56.9% based upon structured review of the provider note. After implementation, documented adherence increased to 75.6% (p<0.01). CT pulmonary angiogram yield remained unchanged, and was 10.4% during the control period and 10.1% after the intervention (p=0.88). Discussion—Implementation of a clinical decision support tool significantly improved documented adherence to a national quality measure, enabling automated measurement of provider adherence to evidence without the need for resource-intensive chart review. It did not adversely affect the use or yield of CT pulmonary angiograms.