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14 results on '"Schneider, Louise I."'

10. Requiring Clinical Justification to Override Repeat Imaging Decision Support: Impact on CT Use

Author

O’Connor, Stacy D., Sodickson, Aaron D., Ip, Ivan K., Raja, Ali S., Healey, Michael J., Schneider, Louise I., and Khorasani, Ramin

Subjects
Meaningful Use, Radiology Information Systems, Practice Guidelines as Topic, Humans, Unnecessary Procedures, Decision Support Systems, Clinical, Tomography, X-Ray Computed, Article, United States
Abstract

The purpose of this study was to determine the impact of requiring clinical justification to override decision support alerts on repeat use of CT.This before and after intervention study was conducted at a 793-bed tertiary hospital with computerized physician order entry and clinical decision support systems. When a CT order is placed, decision support alerts the orderer if the patient's same body part has undergone CT within the past 90 days. The study cohort included all 28,420 CT orders triggering a repeat alert in 2010. The intervention required clinical justification, selected from a predetermined menu, to override repeat CT decision support alerts to place a CT order; otherwise the order could not be placed and was dropped. The primary outcome, dropped repeat CT orders, was analyzed using three methods: chi-square tests to compare proportions dropped before and after intervention; multiple logistic regression tests to control for orderer, care setting, and patient factors; and statistical process control for temporal trends.The repeat CT order drop rate had an absolute increase of 1.4%; 6.1% (682/11,230) before to 7.5% (1290/17,190) after intervention, which was a 23% relative change (7.5 - 6.1)/6.1 × 100 = 23%; p0.0001). Orders were dropped more often after intervention (odds ratio, 1.3; 95% CI, 1.1-1.4; p0.0001). Statistical control analysis supported the association between the increase in the drop rate with intervention rather than underlying trends.Adding a requirement for clinical justification to override alerts modestly but significantly improves the impact of repeat CT decision support (23% relative change), with the overall effect of preventing one in 13 repeat CT orders.

Published
2014

13. Cytogenetics—An Aid to Histopathology in Malignant Lymphomas

Author

Spiers, A. S. D., Neiman, R. S., Lord, Karen E., Deal, D. R., Spiers, A. S. D., and Schneider, Louise I.

Abstract

To the Editor.—Because of their objectivity, cytogenetic studies are a valuable diagnostic aid in leukemias, myeloproliferative syndromes,1 and in suspected malignant effusions2—conditions where diagnosis is cytological, subjective, and often difficult. Malignant lymphomas often present problems of histological diagnosis, but few reports3 describe use of cytogenetics as an aid to histopathology. In two of our patients, malignant lymphoma could not be diagnosed histologically, but the diagnosis was supported by cytogenetic findings; in one case this was borne out by clinical events.Report of Cases.—Case 1.—A 71-year-old man had generalized lymphadenopathy; an inguinal node biopsy specimen was diagnosed as histiocytic lymphoma or malignant histiocytosis. The patient was treated for 13 months with an antineoplastic regimen of cyclophosphamide, vincristine sulfate, prednisone (COP). Afterwards he was well for three years, and then generalized mild lymphadenopathy developed. An axillary node biopsy specimen showed follicular and interfollicular hyperplasia, with numerous

Published
1979
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14. Journal club: Requiring clinical justification to override repeat imaging decision support: impact on CT use.

Author

O'Connor SD, Sodickson AD, Ip IK, Raja AS, Healey MJ, Schneider LI, and Khorasani R

Subjects
Humans, United States, Decision Support Systems, Clinical statistics & numerical data, Meaningful Use statistics & numerical data, Practice Guidelines as Topic, Radiology Information Systems standards, Tomography, X-Ray Computed statistics & numerical data, Unnecessary Procedures statistics & numerical data
Abstract

Objective: The purpose of this study was to determine the impact of requiring clinical justification to override decision support alerts on repeat use of CT., Subjects and Methods: This before and after intervention study was conducted at a 793-bed tertiary hospital with computerized physician order entry and clinical decision support systems. When a CT order is placed, decision support alerts the orderer if the patient's same body part has undergone CT within the past 90 days. The study cohort included all 28,420 CT orders triggering a repeat alert in 2010. The intervention required clinical justification, selected from a predetermined menu, to override repeat CT decision support alerts to place a CT order; otherwise the order could not be placed and was dropped. The primary outcome, dropped repeat CT orders, was analyzed using three methods: chi-square tests to compare proportions dropped before and after intervention; multiple logistic regression tests to control for orderer, care setting, and patient factors; and statistical process control for temporal trends., Results: The repeat CT order drop rate had an absolute increase of 1.4%; 6.1% (682/11,230) before to 7.5% (1290/17,190) after intervention, which was a 23% relative change (7.5 - 6.1)/6.1 × 100 = 23%; p < 0.0001). Orders were dropped more often after intervention (odds ratio, 1.3; 95% CI, 1.1-1.4; p < 0.0001). Statistical control analysis supported the association between the increase in the drop rate with intervention rather than underlying trends., Conclusion: Adding a requirement for clinical justification to override alerts modestly but significantly improves the impact of repeat CT decision support (23% relative change), with the overall effect of preventing one in 13 repeat CT orders.

Published
2014
Full Text
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