Ruth M. Dunne MBBCh, Presenter: Nothing to Disclose

Ivan Ip MD, MPH, Abstract Co-Author: Nothing to Disclose

Sarah K. Abbett MD, MPH, Abstract Co-Author: Nothing to Disclose

Ali Raja MD, MBA, Abstract Co-Author: Medical Advisor, Diagnotion, LLC

Andetta Rotilla Hunsaker MD, Abstract Co-Author: Nothing to Disclose

Ramin Khorasani MD, Abstract Co-Author: Stockholder, Medicalis Corp Royalties, Medicalis Corp Advisory Board, General Electric Company

Esteban Gershanik MD, MPH, Abstract Co-Author: Stockholder, General Electric Company Stockholder, Amgen Inc Stockholder, Johnson & Johnson Stockholder, Eli Lilly and Company Stockholder, Pfizer Inc Stockholder, Merck & Co, Inc Stockholder, Allscripts Healthcare Solutions, Inc Stockholder, Savient Pharmaceuticals, Inc

To determine the effect of evidence-based CDS on the use and yield of inpatient CTPA for acute pulmonary embolism (PE).

This HIPAA-compliant study included all adult inpatients at a 793-bed quaternary care hospital between April 1, 2007, and June 30, 2012. The intervention incorporated previously validated decision rules regarding clinical suspicion for PE and D-dimer measurement in low/intermediate risk patients. CTPA utilization was obtained from the institutional radiology information system. Using a validated natural language processing algorithm, each study was classified as positive for acute PE or not based on radiology report analysis. Admission data was gathered from administrative claims database. Clinical data, including use of prophylactic anticoagulation, was obtained from patient’s electronic medical record. Primary outcome measure was quarterly utilization intensity of inpatient CTPA, defined as the number of examinations performed per quarter per case-mix-adjusted admissions (CMAAs), a product of gross number of admissions and Centers for Medicare & Medicaid Services’ case-mix index of diagnosis-related groups for each quarter. Secondary outcome was the imaging yield, defined as the percentage of examinations positive for diagnosis of acute PE. Outcomes were compared before and after CDS implementation in October 2009. Chi-square was used to assess for differences in CTPA use and yield between the pre- and post-implementation periods. A two-tailed p-value of <0.05 was considered statistically significant.

Of 227,418 in-patient admissions, 5893 (2.6%) patients underwent CTPA. Mean quarterly CTPA use per CMAAs was 0.0102 ± 0.00072 prior to CDS implementation. After CDS implementation, quarterly use per CMAAs decreased significantly to 0.0082 ± 0.00046 (P<0.001). Mean quarterly CT pulmonary angiography yield was 10.9% ± 1.6 prior to CDS implementation. While mean quarterly yield increased to 12.0% ± 2.1 following CDS implementation, this difference was not significant (P=0.244).

Use of evidence-based CDS in the in-patient setting was associated with a significant decrease in use of CT pulmonary angiography for the evaluation of acute PE.

Implementation of evidence-based CDS may significantly decrease the use of inpatient CT pulmonary angiography in the evaluation of acute PE without a decrease in study yield.

Dunne, R, Ip, I, Abbett, S, Raja, A, Hunsaker, A, Khorasani, R, Gershanik, E, Effect of Computerized Evidence-based Clinical Decision Support (CDS) on the Use and Yield of Computed Tomography Pulmonary Angiography (CTPA) in the Inpatient Setting.  Radiological Society of North America 2013 Scientific Assembly and Annual Meeting, December 1 - December 6, 2013 ,Chicago IL. http://archive.rsna.org/2013/13017286.html