Appropriateness Projects
Significant change is coming to diagnostic imaging (DI) care. In Canada, and elsewhere, the change drivers are clear: mounting fiscal pressures, increasing concern with radiation safety and growing evidence of clinically ineffective use. These pressures will shape responses to a range of issues such as hybrid diagnostic imaging, personnel substitution and equipment replacement.
A solution in one area, that of appropriateness or clinical effectiveness of DI exam requests, could significantly impact not only clinically ineffective use but the other health care drivers as well.
Medical imaging is a critical component of the care that health professionals provide. However, mounting evidence demonstrates that between 10 -20% of imaging studies are unnecessary. Any clinical intervention without clear purpose or patient benefit creates waste and negatively affects quality of care. Rising costs alone for DI are a looming threat to health system sustainability. Spending for diagnostic imaging in Canada has increased markedly and now exceeds an estimated $2.2 billion in operational costs alone. Eliminating even 10% of unnecessary tests could eradicate $220 million in wasteful spending each year.
CAR imaging referral guidelines have been available in booklet, PDF and CD formats and on physician websites. CAR recognized that for maximal effect guidelines must be made seamlessly available as part of the clinician’s regular workflow. To achieve this, the CAR guidelines have been integrated into a computerized physician order entry (CPOE) system for diagnostic imaging with attendant computerized clinical decision support (CCDS). The CAR believes that this is the most effective way of implementing guidelines to ensure that DI resources are used most appropriately and effectively.
The CAR has tested the effectiveness of providing its Diagnostic Imaging Referral Guidelines through the computerized clinical decision support and CPOE. Read the results below: