Effect of clinical decision rules, patient cost and malpractice information on clinician brain CT image ordering: a randomized controlled trial
Abstract Background The frequency of head computed tomography (CT) imaging for mild head trauma patients has raised safety and cost concerns. Validated clinical decision rules exist in the published literature and on-line sources to guide medical image ordering but are often not used by emergency de...
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| Format: | Article |
| Language: | English |
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BMC
2018-03-01
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| Series: | BMC Medical Informatics and Decision Making |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12911-018-0602-1 |
| _version_ | 1819031216632889344 |
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| author | Ronald W. Gimbel Ronald G. Pirrallo Steven C. Lowe David W. Wright Lu Zhang Min-Jae Woo Paul Fontelo Fang Liu Zachary Connor |
| author_facet | Ronald W. Gimbel Ronald G. Pirrallo Steven C. Lowe David W. Wright Lu Zhang Min-Jae Woo Paul Fontelo Fang Liu Zachary Connor |
| author_sort | Ronald W. Gimbel |
| collection | DOAJ |
| description | Abstract Background The frequency of head computed tomography (CT) imaging for mild head trauma patients has raised safety and cost concerns. Validated clinical decision rules exist in the published literature and on-line sources to guide medical image ordering but are often not used by emergency department (ED) clinicians. Using simulation, we explored whether the presentation of a clinical decision rule (i.e. Canadian CT Head Rule - CCHR), findings from malpractice cases related to clinicians not ordering CT imaging in mild head trauma cases, and estimated patient out-of-pocket cost might influence clinician brain CT ordering. Understanding what type and how information may influence clinical decision making in the ordering advanced medical imaging is important in shaping the optimal design and implementation of related clinical decision support systems. Methods Multi-center, double-blinded simulation-based randomized controlled trial. Following standardized clinical vignette presentation, clinicians made an initial imaging decision for the patient. This was followed by additional information on decision support rules, malpractice outcome review, and patient cost; each with opportunity to modify their initial order. The malpractice and cost information differed by assigned group to test the any temporal relationship. The simulation closed with a second vignette and an imaging decision. Results One hundred sixteen of the 167 participants (66.9%) initially ordered a brain CT scan. After CCHR presentation, the number of clinicians ordering a CT dropped to 76 (45.8%), representing a 21.1% reduction in CT ordering (P = 0.002). This reduction in CT ordering was maintained, in comparison to initial imaging orders, when presented with malpractice review information (p = 0.002) and patient cost information (p = 0.002). About 57% of clinicians changed their order during study, while 43% never modified their imaging order. Conclusion This study suggests that ED clinician brain CT imaging decisions may be influenced by clinical decision support rules, patient out-of-pocket cost information and findings from malpractice case review. Trial registration NCT03449862, February 27, 2018, Retrospectively registered. |
| first_indexed | 2024-12-21T06:42:32Z |
| format | Article |
| id | doaj.art-dc02e2e9bad443aca995a4e47f05fd10 |
| institution | Directory Open Access Journal |
| issn | 1472-6947 |
| language | English |
| last_indexed | 2024-12-21T06:42:32Z |
| publishDate | 2018-03-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Medical Informatics and Decision Making |
| spelling | doaj.art-dc02e2e9bad443aca995a4e47f05fd102022-12-21T19:12:40ZengBMCBMC Medical Informatics and Decision Making1472-69472018-03-011811810.1186/s12911-018-0602-1Effect of clinical decision rules, patient cost and malpractice information on clinician brain CT image ordering: a randomized controlled trialRonald W. Gimbel0Ronald G. Pirrallo1Steven C. Lowe2David W. Wright3Lu Zhang4Min-Jae Woo5Paul Fontelo6Fang Liu7Zachary Connor8Department of Public Health Sciences, Clemson UniversityDepartment of Emergency Medicine, Greenville Health SystemDepartment of Radiology, Greenville Health SystemDepartment of Emergency Medicine, Emory UniversityDepartment of Public Health Sciences, Clemson UniversityDepartment of Public Health Sciences, Clemson UniversityLister Hill National Center for Biomedical Communication, National Library of MedicineLister Hill National Center for Biomedical Communication, National Library of MedicineDepartment of Public Health Sciences, Clemson UniversityAbstract Background The frequency of head computed tomography (CT) imaging for mild head trauma patients has raised safety and cost concerns. Validated clinical decision rules exist in the published literature and on-line sources to guide medical image ordering but are often not used by emergency department (ED) clinicians. Using simulation, we explored whether the presentation of a clinical decision rule (i.e. Canadian CT Head Rule - CCHR), findings from malpractice cases related to clinicians not ordering CT imaging in mild head trauma cases, and estimated patient out-of-pocket cost might influence clinician brain CT ordering. Understanding what type and how information may influence clinical decision making in the ordering advanced medical imaging is important in shaping the optimal design and implementation of related clinical decision support systems. Methods Multi-center, double-blinded simulation-based randomized controlled trial. Following standardized clinical vignette presentation, clinicians made an initial imaging decision for the patient. This was followed by additional information on decision support rules, malpractice outcome review, and patient cost; each with opportunity to modify their initial order. The malpractice and cost information differed by assigned group to test the any temporal relationship. The simulation closed with a second vignette and an imaging decision. Results One hundred sixteen of the 167 participants (66.9%) initially ordered a brain CT scan. After CCHR presentation, the number of clinicians ordering a CT dropped to 76 (45.8%), representing a 21.1% reduction in CT ordering (P = 0.002). This reduction in CT ordering was maintained, in comparison to initial imaging orders, when presented with malpractice review information (p = 0.002) and patient cost information (p = 0.002). About 57% of clinicians changed their order during study, while 43% never modified their imaging order. Conclusion This study suggests that ED clinician brain CT imaging decisions may be influenced by clinical decision support rules, patient out-of-pocket cost information and findings from malpractice case review. Trial registration NCT03449862, February 27, 2018, Retrospectively registered.http://link.springer.com/article/10.1186/s12911-018-0602-1Clinical decision makingCT brainMild head traumaPatient cost informationSimulation researchMalpractice information |
| spellingShingle | Ronald W. Gimbel Ronald G. Pirrallo Steven C. Lowe David W. Wright Lu Zhang Min-Jae Woo Paul Fontelo Fang Liu Zachary Connor Effect of clinical decision rules, patient cost and malpractice information on clinician brain CT image ordering: a randomized controlled trial BMC Medical Informatics and Decision Making Clinical decision making CT brain Mild head trauma Patient cost information Simulation research Malpractice information |
| title | Effect of clinical decision rules, patient cost and malpractice information on clinician brain CT image ordering: a randomized controlled trial |
| title_full | Effect of clinical decision rules, patient cost and malpractice information on clinician brain CT image ordering: a randomized controlled trial |
| title_fullStr | Effect of clinical decision rules, patient cost and malpractice information on clinician brain CT image ordering: a randomized controlled trial |
| title_full_unstemmed | Effect of clinical decision rules, patient cost and malpractice information on clinician brain CT image ordering: a randomized controlled trial |
| title_short | Effect of clinical decision rules, patient cost and malpractice information on clinician brain CT image ordering: a randomized controlled trial |
| title_sort | effect of clinical decision rules patient cost and malpractice information on clinician brain ct image ordering a randomized controlled trial |
| topic | Clinical decision making CT brain Mild head trauma Patient cost information Simulation research Malpractice information |
| url | http://link.springer.com/article/10.1186/s12911-018-0602-1 |
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