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DISCLOSURES |
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P.D.
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- Nothing to disclose.
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C.S.
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- Technical Consultant, Nuance Communications, Inc
Technical Consultant, Commissure, Inc
Medical Advisory Board, Nuance Communications, Inc
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M.K.
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- Research grant, General Electric Company
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J.W.
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- Nothing to disclose.
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D.R.
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- Scientific Advisory Board, Covidien AG
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K.D.
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- Employee, Perceptics, LLC
Medical Advisor, Perceptics, LLC
Medical Advisor, Agfa-Gevaert Group
Medical Advisor, FUJIFILM Holdings Corporation
Medical Advisor, General Electric Company
Medical Advisor, McKesson Corporation
Medical Advisor, AuntMinnie.com
Medical Advisor, AMICAS, Inc
Medical Advisor, Dynamic Imaging, LLC
Medical Advisor, Ascom Holding AG
Medical Advisor, Bracco Group
Medical Advisor, Merge Healthcare
Medical Advisor, Emageon, Inc
Medical Advisor, RCG HealthCare Consulting
Medical Advisor, Valley Radiology Medical Associates, Inc
Medical Advisor, The Elizabeth Wende Breast Clinic
Medical Advisor, ISCI
Medical Advisor, Siemens AG
Medical Advisor, Barco nv
Medical Advisor, Hue AS
Medical Advisor, Planar Systems, Inc
Medical Advisor, Vital Images, Inc
Medical Advisor, Commissure, Inc
Medical Advisor, TeraRecon, Inc
Medical Advisor, Mercury Computer Systems, Inc
Medical Advisor, IBM Corporation
Medical Advisor, Hewlett-Packard Company
Medical Advisor, EMC Corp
Medical Advisor, Phase Forward Incorporated
Medical Advisor, Winchester Systems, Inc
Medical Advisor, Dell Inc
Medical Advisor, Eastman Kodak Company
Medical Advisor, Amirsys, Inc
Medical Advisor, Reed Elsevier
Committee member, Diagnostic Imaging
Committee member, AuntMinnie.com
Committee member, Imaging Economics
Author, Springer Science+Business Media Deutschland GmbH
Shareholder, Microsoft Corporation
Shareholder, Intel Corporation
Shareholder, IBM Corporation
Shareholder, Hewlett-Packard Company
Shareholder, Dell Inc
Shareholder, General Electric Company
Shareholder, Siemens AG
Shareholder, Google Inc
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| | PURPOSE |
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A Computerized Radiology Order Entry-Decision Support (ROE-DS) program at our institution was developed for ordering high cost imaging exams by providing real-time appropriateness feedback. The purpose of our study was to quantify the size and significance of the effect of ROE-DS on the growth of outpatient CT exams in a single tertiary healthcare center.
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| | METHOD AND MATERIALS |
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A clinical radiology data repository was queried to obtain quarterly counts of outpatient CT scans from 2001 through 2007. The resulting set of 28 sequential counts were analyzed as an interrupted time series using piecewise linear regression with the breakpoint set at period 15 (Q4 of 2004, when ROE-DS was implemented). This technique, implemented with SAS software, allowed simultaneous estimation of two slopes. These represented quarterly CT volume growth in periods 1-15 (before ROE-DS) and quarterly CT volume growth in periods 16-28 (after ROE-DS). This procedure was repeated on log transformed quarterly volumes to interpret the resulting slope estimates (and change after ROE-DS) as quarterly percent growth rates, analogous to economic inflation.
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| | RESULTS |
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The quarterly outpatient CT volume increased from 8013(Q1 2001) to 14293(Q4 2004) and then decreased to 13453(Q4 2007). The estimated pre ROE-DS slope (increase in volume per quarter) was 329 (95% CI=270-390) and post ROE-DS slope was 47 (95% CI=-18 to 112). The estimated difference in these two slopes (i.e. the effect of ROE-DS on quarterly increase in CT volume) was significantly (p<0.0001) lower than zero at -283 CT scans per quarter. Slopes obtained using log transformed volume data (multiplied by 100 to obtain compound quarterly growth rate in percent) were as follows. Pre ROE-DS; 3.1% (95% CI=2.6-3.6%) and post ROE-DS; 0.2% (95% CI=-2.9-7.9%). The estimated change in quarterly growth rate was significantly (p=0.039) less than zero at -2.8%. After ROE-DS, the absolute quarterly growth in CT volume and percentage growth rate were statistically indistinguishable from being essentially flat at the 0.05 level of significance (the 95% CI on both estimates contain zero).
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| | CONCLUSION |
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The implementation of ROE-DS was associated with a subsequent decrease in the quarterly growth rate of outpatient CT volume of 2.8% (from 3.1% to 0.2%).
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| | CLINICAL RELEVANCE/APPLICATION |
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Adoption of computerized radiology order entry with decision support can substantially decrease the growth of outpatient CT volumes.
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QUESTIONS ABOUT THIS EVENT EMAIL: |
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pdang1@partners.org |
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