Congress:
EuroSafe Imaging 2016
Keywords:
Decision analysis, RIS, Computer applications, Action 1 - Guidelines, implementation policies, and Clinical Decision Support (ESR iGuide), Action 1 - Clinical decision support, clinical imaging guidelines, Education and training
Authors:
L. Donoso, M. G. M. Hunink
DOI:
10.1594/esi2016/ESI-0051
Description of activity and work performed
Following an agreement with the ACR in 2014 that enabled the ESR to use their well-established Appropriateness Criteria,
developed over the past 25 years by 12 expert panels,
an ESR-appointed team of specialists from various areas of clinical radiology conducted a scientific review of the ACR’s criteria in order to adapt them for use in the European setting.
Led by a dedicated methodologist,
the ESR’s European Imaging Referral Guidelines constitute a common set of standard guidelines for use in Europe in a format that enables users to localise the guidelines according to national requirements or institutional circumstances.
This ‘Europeanisation’ process carried out in 2015 is the first step towards the ESR and ACR’s shared vision of developing a joint set of global,
evidence-based guidelines in the future.
The ESR and NDSC Europe are now in the process of bringing the benefits of CDS to Europe.
With ACR Select (the CDS system distributed in the United States by the ACR and NDSC since 2012) installed at more than 100 US sites,
the impact of making referral guidelines available to referrers within their workflow at the point of care has been demonstrated.
At Massachusetts General Hospital,
which has pioneered the use of CDS to improve imaging utilisation,
the high growth rates for imaging exams were lowered by eliminating unnecessary,
inappropriate or duplicate examinations,
which in the example of CT scans has protected patients from significant radiation exposure with no or limited diagnostic benefit.
Similarly,
in a state-wide study in Minnesota CDS was successfully used to stem the tide of an ever-increasing number of scans by making sure orders adhere to evidence-based medicine standards.
In Europe,
a pilot project using a Spanish version of ACR Select in a European setting at the Hospital Clinic Barcelona ran from 2013 to 2015 is currently being evaluated.
The study on the impact of the introduction of an evidence-based decision support tool for diagnostic imaging tests referrals from outpatient care will be published in 2016.
The Hospital Clinic of Barcelona aimed to improve appropriateness and efficiency of imaging referrals from primary health care physicians.
ACR Select was integrated into the existing information system for test referrals in three primary health care centres of the influence area of the Hospital.
A retrospective study before (January-April 2014) and after (January-April 2015) the implementation of ACR Select looking at the impact of the ACR Criteria on quantity and characteristics of test referrals is being carried out,
while the impact on health outcomes at primary health care level and associated changes in costs of tests prescribed are also being studied.
Preliminary analysis of some of the variables show that there are some statistically significant changes in the mean number of tests requested before and after the implementation of ACR Select for some specific clinical indications.
Rough data analysis also show differences in the types of tests prescribed for specific clinical conditions before and after the implementation of the ACR Appropriatness Criteria.