{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T08:28:01Z","timestamp":1771489681847,"version":"3.50.1"},"reference-count":26,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2021,2,12]],"date-time":"2021-02-12T00:00:00Z","timestamp":1613088000000},"content-version":"unspecified","delay-in-days":11,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000867","name":"Robert Wood Johnson Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000867","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["1K24AG047899-01"],"award-info":[{"award-number":["1K24AG047899-01"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["2P30AG081684"],"award-info":[{"award-number":["2P30AG081684"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences","doi-asserted-by":"publisher","award":["KL2TR001882"],"award-info":[{"award-number":["KL2TR001882"]}],"id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences","doi-asserted-by":"publisher","award":["UL1TR001881"],"award-info":[{"award-number":["UL1TR001881"]}],"id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open Qual"],"accepted":{"date-parts":[[2020,10,24]]},"published-print":{"date-parts":[[2021,2]]},"abstract":"<jats:sec>\n                  <jats:title>Importance<\/jats:title>\n                  <jats:p>Electronic health record (EHR) clinical decision support (CDS) tools can provide evidence-based feedback at the point of care to reduce low-value imaging. Success of these tools has been limited partly due to lack of engagement by busy clinicians.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>Measure the impact of a time-saving quality improvement intervention to increase engagement with a CDS tool for low back pain imaging ordering.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design, setting and participants<\/jats:title>\n                  <jats:p>We conducted a quasi-experimental difference-in-differences analysis at (BLINDED), examining back pain imaging orders from 29 May 2015 to 07 January 2016. The intervention site was (BLINDED) Emergency Medicine\/Urgent Care Center (n=5736) and control sites included all other (BLINDED) hospitals and clinics (n=1621). In May 2015, the Department of Health Services installed a CDS tool that triggered a survey when clinicians ordered an imaging test, generating an \u2018appropriateness score\u2019 based on the American College of Radiology guidelines. Clinicians often bypassed the tool, resulting in \u2018unscored\u2019 tests.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Intervention<\/jats:title>\n                  <jats:p>To increase clinician engagement with the tool and decrease the rate of unscored imaging tests, a new policy was implemented at the intervention site on 15 August 2015. If clinicians completed the CDS survey and scored an appropriateness score &gt;3, they could forego a previously mandatory telephone call for pre-imaging utilisation review with the radiology department.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Main outcomes and measures<\/jats:title>\n                  <jats:p>We used EHR data to measure pre\u2013post-intervention differences in: (1) percentage of unscored tests and (2) percentage of tests with high appropriateness scores (&gt;7).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Percentage of unscored tests decreased from 69.4% to 10.4% at the intervention site and from 50.6% to 34.8% at the control sites (between-group difference: \u221223.3%, p&lt;0.001). Percentage of high scoring tests increased from 26.5% to 75.0% at the intervention site and from 17.2% to 22.7% at the control sites (between-group difference: 19%, p&lt;0.001).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Workflow time-saving interventions may increase physician engagement with CDS tools and have potential to improve practice patterns.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjoq-2020-001076","type":"journal-article","created":{"date-parts":[[2021,2,12]],"date-time":"2021-02-12T11:50:05Z","timestamp":1613130605000},"page":"e001076","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":11,"title":["Quality improvement time-saving intervention to increase use of a clinical decision support tool to reduce low-value diagnostic imaging in a safety net health system"],"prefix":"10.1136","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8721-8840","authenticated-orcid":false,"given":"Bryanna","family":"Lee","sequence":"first","affiliation":[{"name":"University of California Los Angeles Value-Based Care Research Consortium, Los Angeles, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John","family":"Mafi","sequence":"additional","affiliation":[{"name":"University of California Los Angeles Value-Based Care Research Consortium, Los Angeles, California, USA"},{"name":"Division of General Internal Medicine and Health Services Research, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maitraya K","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Radiological Sciences, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea","family":"Sorensen","sequence":"additional","affiliation":[{"name":"University of California Los Angeles Value-Based Care Research Consortium, Los Angeles, California, USA"},{"name":"Division of Geriatrics, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sitaram","family":"Vangala","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine and Health Services Research, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eric","family":"Wei","sequence":"additional","affiliation":[{"name":"Office of Quality and Safety, New York City Health and Hospitals, New York, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2768-2323","authenticated-orcid":false,"given":"Catherine","family":"Sarkisian","sequence":"additional","affiliation":[{"name":"University of California Los Angeles Value-Based Care Research Consortium, Los Angeles, California, USA"},{"name":"Division of Geriatrics, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA"},{"name":"Veterans Administration Greater Los Angeles Healthcare System Geriatrics Research Education & Clinical Center, Los Angeles, California, 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