近期，德国奥格斯堡大学医院Thomas Kroencke团队评估了影像请求临床决策支持系统的适用性。2025年2月10日，《美国医学会杂志》发表了这一成果。

鉴于医学成像的广泛使用，评估干预措施的有效性以提高对于优化卫生保健资源和患者预后的适当性至关重要。为了评估实施欧洲放射学会iGuide临床决策支持系统（CDSS）对医生医学影像请求行为适当性的影响，研究组以德国3所大学医院26个科室为组群，纳入停药前后设计的整群随机临床试验。包括参与部门医生在2.5年期间（2021年12月至2024年6月）提出的所有成像请求。

所有科室开始时都没有CDSS，需要结构化的临床指征数据输入和所要求的影像跟踪。随机分组后，13个组（医院科室）接受了CDSS干预（干预组），13个组（对照组）未接受CDSS干预。CDSS干预为请求医生提供信息，证明他们的影像要求是否合适、在某些情况下是否合适、或是否不合适；此外，CDSS还建议了其他诊断测试，包括相应的适当性评分，之后医生可以选择修改他们的成像要求。主要结局指标是每个科室提出的不适当影像学要求的比例。采用差异分析来调查有和没有CDSS的科室之间不适当成像请求比例的变化。

使用CDSS对总共65764个成像请求进行了评分；50.1%的影像学请求是针对女性患者的，患者的平均年龄为64岁（标准差，17.1岁）。在实施CDSS之前，对照集群有21625个成像请求，其中1367个（6.3%）被归类为不合适；干预集群有13338个成像请求，其中1007个（7.6%）被归类为不合适。实施CDSS后，对照集群有1055个成像请求，其中518个（5.2%）被归类为不合适；干预集群有7206个成像请求，其中461个（6.4%）被归类为不合适。与对照组相比，干预组在不适当的成像请求方面显示出类似的减少（平均差异为-0.5%[99%CI，-2.4%至0.4%]），差异值为1.3个百分点（99%CI，-2.0至1.8个百分点；P = .69），差异无统计学意义。

研究结果表明，CDSS并没有减少医生在学术医院设置的不适当的成像请求。

Title: Evaluation of a Clinical Decision Support System for Imaging Requests: A Cluster Randomized Clinical Trial

Author: Stijntje W. Dijk, Claudia Wollny, Joerg Barkhausen, Olav Jansen, Peter Mildenberger, Moritz C. Halfmann, Jonas Stroeder, Dimitris Rizopoulos, M. G. Myriam Hunink, Thomas Kroencke

Issue&Volume: 2025-02-10

Abstract:

Importance  Given the widespread use of medical imaging, evaluating the effectiveness of interventions to improve appropriateness is crucial for optimizing health care resources and patient outcomes.

Objective  To assess the effects of implementing a clinical decision support system (CDSS), the European Society of Radiology iGuide, on the appropriateness of the medical imaging ordering behavior of physicians.

Design and Setting  A cluster randomized clinical trial with 26 departments at 3 German university hospitals acting as clusters, incorporating a before and after discontinued design. All imaging requests originating from physicians in the participating departments over a 2.5-year period were included (between December 2021 and June 2024).

Interventions  All departments started without a CDSS and required structured clinical indication data entry and tracking of requested imaging. After randomization, 13 clusters (departments at hospitals) received the CDSS intervention (intervention clusters) and 13 clusters did not (control clusters). The CDSS intervention provided ordering physicians with information as to whether their imaging requests were appropriate, appropriate under certain conditions, or inappropriate; in addition, alternative diagnostic tests, including the corresponding appropriateness score, were suggested by the CDSS, after which physicians could choose to modify their imaging requests.

Main Outcomes and Measures  The primary outcome measure was the proportion of inappropriate imaging requests made per department. A difference-in-differences analysis was used to investigate changes in the proportion of inappropriate imaging requests between departments with vs those without the CDSS.

Results  A total of 65764 imaging requests were scored using the CDSS; 50.1% of imaging requests were for female patients and the mean patient age was 64 years (SD, 17.1 years). Prior to implementation of the CDSS, there were 21625 imaging requests from the control clusters, 1367 (6.3%) of which were categorized as inappropriate; and there were 13338 imaging requests from the intervention clusters, 1007 (7.6%) of which were categorized as inappropriate. After implementation of the CDSS, there were 10055 imaging requests from the control clusters, 518 (5.2%) of which were categorized as inappropriate; and there were 7206 imaging requests from the intervention clusters, 461 (6.4%) of which were categorized as inappropriate. The intervention clusters showed a similar reduction (mean difference, 0.5% [99% CI, 2.4% to 0.4%]) in inappropriate imaging requests compared with the control clusters (mean difference, 1.8% [99% CI, 4.3% to 0.4%]) and there was a difference-in-differences value of 1.3 percentage points (99% CI, 2.0 to 1.8 percentage points; P=.69), which was not statistically significant.

Conclusions and Relevance  The CDSS did not reduce the number of inappropriate imaging requests ordered by physicians in academic hospital settings.

DOI: 10.1001/jama.2024.27853

Source: https://jamanetwork.com/journals/jama/fullarticle/2830127