Development and Investigation of an Appropriateness Guideline-based Mobile Application to Support Physicians' Head CT Scan Ordering: A Quasi-experimental Study (Preprint)
Authors: Meidani Zahra , Atoof Fateme , Mobarak Zohreh , Daneshvar Reza , Kochaki Ebrahim , Nabovati Ehsan , Fakharian Esmaeel , Holl Felix , Nickfarjam Alimohammad , Masoud Ali 
Published: December 2020

BACKGROUND

Although many medical apps are already available for the use of health care professionals (HCP), there is scarce objective evidence regarding the intention of using mobile apps by HCP; and the effectiveness of using mobile applications among physicians is still unclear. Thus, understanding the contributing factors in the successful adoption of mobile applications by healthcare professionals is critical for various stakeholders, including patients, health care decision-makers, insurance companies, and industry such as major stakeholders in mobile app stores.

OBJECTIVE

To address this challenge, this study seeks two objectives: 1) design & implement a head CT scan appropriateness guideline mobile app (HAC app) for residents CT scan ordering; 2) investigate the impact of the HAC app on physicians' ordering behavior.

METHODS

Following the study conducted on the CT utilization by "utilization management and cost-conscious care committee (UM3C)", we performed a quasi-experimental study with all neurology and neurosurgery residents in a given general teaching hospital with 510 beds in Iran. We selected the Care Core Head CT Scan guideline for the mobile application. HAC app impact on CT utilization was investigated for seven months at three points: before the intervention, during the intervention, and after the intervention. Data for CT scan utilization were collected using a checklist and medical records and then analyzed using descriptive statistics, Chi-square, and Fisher's exact test. At the end of the study, we conducted a reflection session through the focus group discussion with residents to review and digest residents' experiences during interaction with the HAC app.

RESULTS

Total brain CT utilization for seven months was 920. The median CT ordered per patient in the baseline phase (before intervention) was 2 (Q1=1, Q3=4), during the intervention phase was 2 (Q1= 1, Q3=2) and in two months after cessation of the intervention phase was 2 (Q1=1, Q3=2). The decrease of total CT scan utilization was statistically significant during pre-intervention and intervention phases (P= 0.027). No significant differences were found for total brain CT utilization during the intervention and after the intervention phase (P= 0.075). Two key themes were extracted during the reflection session and categorized into the future HAC app and its drawbacks.

CONCLUSIONS

Mobile devices affect residents' CT scan ordering behavior; whereas this impact was not long-lasting, the direct cause- and effect relationship between the mobile apps and changing physicians' behavior remains open to debate. The lack of objective studies in evaluating mobile apps' impact on clinical care outcome prevents individual judgment on its effectiveness. Further studies based on real interactive experiences with mobile systems is advisable to investigate contributing factors in physicians' mobile intention of use before it can be recommended for widespread use by HCP.