Radiologist Point-of-Care Clinical Decision Support and Adherence to Guidelines for Incidental Lung Nodules |
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| Institution: | 1. Official American College of Radiology Representative;4. Official American Heart Association Representative;5. Official Payer, Humana Representative;6. Official American Association for Thoracic Surgery Representative;7. Official Society of Thoracic Surgeons Representative;8. Official Society of Cardiovascular Computed Tomography Representative;9. Official Society of Atherosclerosis Imaging and Prevention Representative;10. Official Society for Cardiovascular Magnetic Resonance Representative;11. Official American College of Emergency Physicians Representative;12. Official Society for Academic Emergency Medicine Representative;13. Official North American Society for Cardiovascular Imaging Representative;14. Official Society for Cardiovascular Patient Care Representative;15. Official American Society of Nuclear Cardiology Representative;p. Official American College of Physicians Representative. Dr. Rosenberg''s representation does not imply ACP endorsement of this guideline;q. Official American Society of Echocardiography Representative. Dr. Ward''s representation does not indicate ASE endorsement of this guideline;r. Official Society of Thoracic Radiology Representative;1. Official American College of Radiology Representative;2. Official American College of Cardiology Representative;3. Official American College of Emergency Physicians Representative;1. Department of Radiology, Duke University Medical Center, Durham, North Carolina;2. Department of Computer Science, Lamar University, Beaumont, Texas;3. Department of Electrical and Computer Engineering, Duke University, Durham, North Carolina;4. Department of Biomedical Engineering, Duke University, Durham, North Carolina |
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| Abstract: | PurposeTo evaluate the effect of a workstation-integrated, point-of-care, clinical decision support (CDS) tool on radiologist adherence to radiology department guidelines for follow-up of incidental pulmonary nodules detected on abdominal CT.MethodsThe CDS tool was developed to facilitate adherence to department guidelines for managing pulmonary nodules seen on abdominal CT. In October 2012, the tool was deployed within the radiology department of an academic medical center and could be used for a given abdominal CT at the discretion of the interpreting radiologist. We retrospectively identified consecutive patients who underwent abdominal CT (in the period from January 2012 to April 2013), had no comparison CT scans available, and were reported to have a solid, noncalcified, pulmonary nodule. Concordance between radiologist follow-up recommendation and department guidelines was compared among three groups: patients scanned before implementation of the CDS tool; and patients scanned after implementation, with versus without use of the tool.ResultsA total of 409 patients were identified, including 268 for the control group. Overall, guideline concordance was higher after CDS tool implementation (92 of 141 65%] versus 133 of 268 50%], P = .003). This finding was driven by the subset of post-CDS implementation cases in which the CDS tool was used (57 of 141 40%]). In these cases, guideline concordance was significantly higher (54 of 57 95%]), compared with post-implementation cases in which CDS was not used (38 of 84 45%], P < .001), and to a control group of patients from before implementation (133 of 268 50%]; P < .001).ConclusionsA point-of-care CDS tool was associated with improved adherence to guidelines for follow-up of incidental pulmonary nodules. |
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| Keywords: | Clinical decision support lung nodule |
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