Early Adoption of a Certainty Scale to Improve Diagnostic Certainty Communication |
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| Institution: | 1. Quality and Safety Officer, Center for Evidence-Based Imaging, Brigham and Women’s Hospital, Boston, Massachusetts;2. Department of Radiology Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts;3. Dana-Farber Cancer Institute, Boston, Massachusetts;4. Center for Evidence-Based Imaging, Brigham and Women’s Hospital, Boston, Massachusetts;5. Chair, Department of Radiology Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts;6. Vice Chair of Quality and Safety, Department of Radiology Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts;7. Director, Center for Evidence-Based Imaging, Brigham and Women''s Hospital, Boston, Massachusetts;1. George Washington University School of Medicine and Health Sciences, Washington, DC;2. Johns Hopkins Medicine, Department of Radiology, Baltimore, Maryland;3. George Washington University Hospital, Department of Radiology, Washington, DC;1. Department of Radiology, Beth-Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts;2. Center for Evidence Based Imaging, Brigham and Women’s Hospital, Boston, Massachusetts;3. MIT Computer Science & Artificial Intelligence Laboratory, Cambridge, Massachusetts;4. Director of Education, Center for Evidence-Based Imaging, Brigham and Women''s Hospital, Director of Clinical Informatics, Harvard Medical School Library of Evidence, Boston, Massachusetts;5. Fraunhofer MEVIS: Institute for Digital Medicine, Bremen, Germany;6. Director of Clinical Decision Group at MIT Computer Science & Artificial Intelligence Laboratory, Cambridge, Massachusetts;7. Director of the Center for Evidence Imaging and Vice Chair of Quality/Safety, Department of Radiology, Brigham and Women’s Hospital, Boston, Massachusetts;1. Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea;2. Department of Radiology, National Health Insurance Service Ilsan Hospital, Goyang, Korea;3. Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Korea;1. Department of Radiology, University of Michigan Medical School, Ann Arbor, Michigan;2. Associate Chair of Department Life and Culture; Department of Radiology University of Michigan Medical School, Ann Arbor, Michigan;3. Quality Improvement Head of Noninvasive Pediatric Cardiac Imaging in the Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan;4. Associate Program Director of the Diagnostic Radiology Residency, Director of Cardiothoracic Medical Student Education, and Director of Cardiothoracic Resident Education in the Department of Radiology, University of Michigan Medical School, Ann Arbor, Michigan;5. Diagnostic Radiology Residency Program Director in the Department of Radiology, University of Michigan Medical School, Ann Arbor, Michigan;6. Division Director of Cardiothoracic Imaging in the Department of Radiology, University of Michigan Medical School, Ann Arbor, Michigan;1. Departments of Radiology and Population Science, Weill Cornell Medicine, New York, New York |
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| Abstract: | ObjectiveAssess the early voluntary adoption of a certainty scale to improve communicating diagnostic certainty in radiology reports.MethodsThis institutional review board–approved study was part of a multifaceted initiative to improve radiology report quality at a tertiary academic hospital. A committee comprised of radiology subspecialty division representatives worked to develop recommendations for communicating varying degrees of diagnostic certainty in radiology reports in the form of a certainty scale, made publicly available online, which specified the terms recommended and the terms to be avoided in radiology reports. Twelve radiologists voluntarily piloted the scale; use was not mandatory. We assessed proportion of recommended terms among all diagnostic certainty terms in the Impression section (primary outcome) of all reports generated by the radiologists. Certainty terms were extracted via natural language processing over a 22-week postintervention period (31,399 reports) and compared with the same 22 calendar weeks 1 year pre-intervention (24,244 reports) using Fisher’s exact test and statistical process control charts.ResultsOverall, the proportion of recommended terms significantly increased from 8,498 of 10,650 (80.0%) pre-intervention to 9,646 of 11,239 (85.8%) postintervention (P < .0001 and by statistical process control). The proportion of recommended terms significantly increased for 8 of 12 radiologists (P < .0005 each), increased insignificantly for 3 radiologists (P > .05), and decreased without significance for 1 radiologist.ConclusionDesigning and implementing a certainty scale was associated with increased voluntary use of recommended certainty terms in a small radiologist cohort. Larger-scale interventions will be needed for adoption of the scale across a broad range of radiologists. |
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| Keywords: | Best practices certainty scale diagnostic certainty report quality |
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