Equity in Diagnostic Imaging Trial
关键词
抽象
描述
Investigators at our institution (Hwang & Richardson)* documented a racial disparity in the use of CT scans to diagnose subarachnoid hemorrhage, (SAH) a life-threatening form of stroke. Subsequent analyses found a similar finding in NHAMCS, a national ED Visit database*. The investigators will compare the effectiveness of 1) an audit-feedback intervention that provides data on race-specific CT rates and 2) a clinical decision support (CDS) message in the electronic "headache" charting template in eliminating the previously observed Black-White disparity in CT rates to rule out SAH.
Study Setting: The adult section of the Mount Sinai Emergency Department, an urban academic department with an annual volume of over 70,000 adult visits and a patient population representing a diverse cross-section of race and socioeconomic groups. The adult patients are cared for by a staff that includes: attending physicians, physician assistants, emergency medicine resident physicians, and rotating resident physicians from other specialties. The department has a dedicated CT scanner that is readily available around the clock. Epic Production is used for all physician and nurse documentation and for all order entry (including CT scans).
Over a 24-month period the investigators will compare the intervention and control groups' rates of testing for SAH across races, controlling for patient acuity, age and co-morbidities. Because the close working relationships among the attending and resident physicians in our department may lead to knowledge diffusion, the intervention may change the behavior of the control group as well as the intervention group, thus leading to an underestimation of the intervention effect as measured by the between- groups difference. The investigators will use a time series design to allow us to evaluate this effect. 10 months after the implementation of the first intervention, the clinical decision support message will be implemented. The impact of each intervention will be evaluated using a repeated measures design using a mixed linear model.
日期
最后验证: | 12/31/2015 |
首次提交: | 04/12/2012 |
提交的预估入学人数: | 05/31/2012 |
首次发布: | 06/04/2012 |
上次提交的更新: | 01/27/2016 |
最近更新发布: | 01/28/2016 |
实际学习开始日期: | 06/30/2010 |
预计主要完成日期: | 11/30/2015 |
预计完成日期: | 11/30/2015 |
状况或疾病
干预/治疗
Other: Audit-feedback
Other: Clinical Decision Support
相
手臂组
臂 | 干预/治疗 |
---|---|
Experimental: Audit-feedback Arm 1: Audit-feedback only | |
Experimental: CDS message Arm 2: CDS message only | |
Experimental: Both Interventions Arm 3: Audit-feedback and CDS message | |
No Intervention: Control Arm 4: Control |
资格标准
有资格学习的年龄 | 18 Years 至 18 Years |
有资格学习的性别 | All |
接受健康志愿者 | 是 |
标准 | Inclusion Criteria: Attending Physicians, Emergency Room Resident Physicians, and PA's will be included if: - they provide care to adult patients in the emergency department of Mount Sinai Hospital. Patients will be enrolled for medical record review if - they present with a complaint of headache and charted on the headache template in the period between four years pre-intervention and the end of the study period. Exclusion Criteria: - anyone who does not meet the inclusion criteria will be excluded from the study |
结果
主要结果指标
1. Change in CT usage rate [up to 24 months]