{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,14]],"date-time":"2026-02-14T06:13:15Z","timestamp":1771049595236,"version":"3.50.1"},"reference-count":10,"publisher":"Springer Science and Business Media LLC","issue":"2","license":[{"start":{"date-parts":[[2021,2,25]],"date-time":"2021-02-25T00:00:00Z","timestamp":1614211200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,2,25]],"date-time":"2021-02-25T00:00:00Z","timestamp":1614211200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Digit Imaging"],"published-print":{"date-parts":[[2021,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>The Protecting Access to Medicare Act (PAMA) mandates clinical decision support mechanism (CDSM) consultation for all advanced imaging. There are a growing number of studies examining the association of CDSM use with imaging appropriateness, but a paucity of multicenter data. This observational study evaluates the association between changes in advanced imaging appropriateness scores with increasing provider exposure to CDSM. Each provider\u2019s first 200 consecutive anonymized requisitions for advanced imaging (CT, MRI, ultrasound, nuclear medicine) using a single CDSM (CareSelect, Change Healthcare) between January 1, 2017 and December 31, 2019 were collected from 288 US institutions. Changes in imaging requisition proportions among four appropriateness categories (\u201cusually appropriate\u201d [green], \u201cmay be appropriate\u201d [yellow], \u201cusually not appropriate\u201d [red], and unmapped [gray]) were evaluated in relation to the chronological order of the requisition for each provider and total provider exposure to CDSM using logistic regression fits and Wald tests. The number of providers and requisitions included was 244,158 and 7,345,437, respectively. For 10,123 providers with \u2265\u00a0200 requisitions (2,024,600 total requisitions), the fraction of green, yellow, and red requisitions among the last 10 requisitions changed by +3.0% (95% confidence interval +2.6% to +3.4%), \u22120.8% (95% CI \u22120.5% to \u22121.1%), and \u22123.0% (95% CI 3.3% to \u22122.7%) in comparison with the first 10, respectively. Providers with &gt;\u00a0190 requisitions had 8.5% (95% CI 6.3% to 10.7%) more green requisitions, 2.3% (0.7% to 3.9%) fewer yellow requisitions, and 0.5% (95% CI \u22121.0% to 2.0%) fewer red (not statistically significant) requisitions relative to providers with \u2264\u00a010 requisitions. Increasing provider exposure to CDSM is associated with improved appropriateness scores for advanced imaging requisitions.<\/jats:p>","DOI":"10.1007\/s10278-021-00433-6","type":"journal-article","created":{"date-parts":[[2021,2,25]],"date-time":"2021-02-25T18:03:19Z","timestamp":1614276199000},"page":"397-403","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Improved Appropriateness of Advanced Diagnostic Imaging After Implementation of Clinical Decision Support Mechanism"],"prefix":"10.1007","volume":"34","author":[{"given":"Leonid L.","family":"Chepelev","sequence":"first","affiliation":[]},{"given":"Xuan","family":"Wang","sequence":"additional","affiliation":[]},{"given":"Benjamin","family":"Gold","sequence":"additional","affiliation":[]},{"given":"Clara-Lea","family":"Bonzel","sequence":"additional","affiliation":[]},{"given":"Frank","family":"Rybicki Jr","sequence":"additional","affiliation":[]},{"given":"Jennifer W","family":"Uyeda","sequence":"additional","affiliation":[]},{"given":"Adnan","family":"Sheikh","sequence":"additional","affiliation":[]},{"given":"Dan","family":"Anderson","sequence":"additional","affiliation":[]},{"given":"Jared","family":"Lindaman","sequence":"additional","affiliation":[]},{"given":"Greg","family":"Mogel","sequence":"additional","affiliation":[]},{"given":"Dimitrios","family":"Mitsouras","sequence":"additional","affiliation":[]},{"given":"Mary C.","family":"Mahoney","sequence":"additional","affiliation":[]},{"given":"Tianxi","family":"Cai","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3005-315X","authenticated-orcid":false,"given":"Frank J.","family":"Rybicki","sequence":"additional","affiliation":[]}],"member":"297","published-online":{"date-parts":[[2021,2,25]]},"reference":[{"key":"433_CR1","unstructured":"Protecting Access to Medicare Act of 2014. In: 113th Congress nS, \u00a7218th edition. HR4302, 2014"},{"key":"433_CR2","unstructured":"Centers for Medicare and Medicaid Services: Appropriate use criteria (AUC) for advanced diagnostic imaging \u2013 educational and operations testing period - claims processing requirements. www.cms.gov. Accessed October 4, 2020"},{"key":"433_CR3","unstructured":"(GAO) USGAO: Medicare Part B imaging services rapid spending growth and shift to physician offices indicate need for CMS to consider additional management practices. 2008. https:\/\/www.gao.gov\/new.items\/d08452.pdf. Accessed October 4, 2020"},{"key":"433_CR4","doi-asserted-by":"crossref","unstructured":"Hussey PS, Timbie JW, Burgette LF, Wenger NS, Nyweide DJ, Kahn KL: Appropriateness of advanced diagnostic imaging ordering before and after implementation of clinical decision support systems. JAMA 313(21):2181\u20132182,2015","DOI":"10.1001\/jama.2015.5089"},{"key":"433_CR5","unstructured":"Centers for Medicare and Medicaid Services: Provider led entities. https:\/\/www.cms.gov\/Medicare\/Quality-Initiatives-Patient-Assessment-Instruments\/Appropriate-Use-Criteria-Program\/PLE. Accessed October 4, 2020"},{"key":"433_CR6","doi-asserted-by":"crossref","unstructured":"Doyle J, Abraham S, Feeney L, Reimer S, Finkelstein A: Clinical decision support for high-cost imaging: A randomized clinical trial. PLoS One 14(3):e0213373,2019","DOI":"10.1371\/journal.pone.0213373"},{"key":"433_CR7","doi-asserted-by":"crossref","unstructured":"Colla CH, Mainor AJ, Hargreaves C, Sequist T, Morden N: Interventions aimed at reducing use of low-value health services: a systematic review. Med Care Res Rev\u00a074(5):507-550,2017","DOI":"10.1177\/1077558716656970"},{"key":"433_CR8","doi-asserted-by":"crossref","unstructured":"Schultz W: Neuronal reward and decision signals: from theories to data. Physiol Rev 95(3):853-951,2015","DOI":"10.1152\/physrev.00023.2014"},{"key":"433_CR9","doi-asserted-by":"crossref","unstructured":"Moriarity AK, Klochko C, O'Brien M, Halabi S: The effect of clinical decision support for advanced inpatient imaging. J Am Coll Radiol 12(4):358-63,2015","DOI":"10.1016\/j.jacr.2014.11.013"},{"issue":"9","key":"433_CR10","doi-asserted-by":"publisher","first-page":"819","DOI":"10.1001\/jama.2019.10158","volume":"322","author":"D Levine","year":"2019","unstructured":"Levine D, Duszak R Jr: Evolving priorities for imaging utilization research: from outputs to outcomes. JAMA 322(9):819-821,2019","journal-title":"JAMA"}],"container-title":["Journal of Digital Imaging"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10278-021-00433-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s10278-021-00433-6\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10278-021-00433-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,7,19]],"date-time":"2021-07-19T14:13:38Z","timestamp":1626704018000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s10278-021-00433-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,2,25]]},"references-count":10,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2021,4]]}},"alternative-id":["433"],"URL":"https:\/\/doi.org\/10.1007\/s10278-021-00433-6","relation":{},"ISSN":["0897-1889","1618-727X"],"issn-type":[{"value":"0897-1889","type":"print"},{"value":"1618-727X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,2,25]]},"assertion":[{"value":"6 October 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 January 2021","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"10 February 2021","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"25 February 2021","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Benjamin Gold BS: Employee of Change Healthcare.Dan Anderson MD: Employee of Change Healthcare.Jared Lindaman BS: Employee of Change Healthcare.Greg Mogel MD: Employee of Change Healthcare.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of Interest"}}]}}