A Clinical Reminder Order Check Intervention to Improve Guideline-concordant Imaging Practices for Men With Prostate Cancer: A Pilot Study

• Published in: Urology (Ridgewood, N.J.) N.J.), 2020-11, Vol.145, p.113-119
• Main Authors: Ciprut, Shannon E., Kelly, Matthew D., Walter, Dawn, Hoffman, Renee, Becker, Daniel J., Loeb, Stacy, Sedlander, Erica, Tenner, Craig T., Sherman, Scott E., Zeliadt, Steven B., Makarov, Danil V.
• Format: Article
• Language: English
• Subjects: Evaluation Studies as Topic; Guideline Adherence - organization & administration; Guideline Adherence - standards; Guideline Adherence - statistics & numerical data; Humans; Male; Medical Order Entry Systems - organization & administration; Medical Order Entry Systems - standards; Medical Order Entry Systems - statistics & numerical data; Medical Overuse - prevention & control; Medical Overuse - statistics & numerical data; Pilot Projects; Practice Guidelines as Topic; Prostate - diagnostic imaging; Prostatic Neoplasms - diagnosis; Reminder Systems; United States
• ISSN: 0090-4295; 1527-9995
• DOI: 10.1016/j.urology.2020.05.101

To understand how to potentially improve inappropriate prostate cancer imaging rates we used National Comprehensive Cancer Network's guidelines to design and implement a Clinical Reminder Order Check (CROC) that alerts ordering providers of potentially inappropriate imaging orders in real-time based on patient features of men diagnosed with low-risk prostate cancer. We implemented the CROC at VA New York Harbor Healthcare System from April 2, 2015 to November 15, 2017. We then used VA administrative claims from the VA's Corporate Data Warehouse to analyze imaging rates among men with low-risk prostate cancer at VA New York Harbor Healthcare System before and after CROC implementation. We also collected and cataloged provider responses in response to overriding the CROC in qualitative analysis. (117/205) of Veterans before CROC installation and 73% (61/83) of Veterans post-intervention with low-risk prostate cancer received guideline-concordant care. While the decrease in inappropriate imaging during our study window was almost certainly due to many factors, a Computerized Patient Record System-based CROC intervention is likely associated with at least moderate improvement in guideline-concordant imaging practices for Veterans with low-risk prostate cancer.