BACKGROUND/RATIONALE:
Patients undergo millions of noninvasive diagnostic imaging tests, including computed tomography (CT), magnetic resonance imaging (MRI), and nuclear medicine, in the United States annually. Based on Appropriate Use Criteria (AUC) developed by professional medical societies, 20-30% of these tests may be inappropriate. One of the most popular strategies for reducing inappropriate, or low-value imaging is an electronic decision support tool (DST). This software is added to care workflows to capture AUC data, that can be used for real-time feedback, audit and feedback, or peer normalization, to improve ordering. A recent VHA Evidence Synthesis Program report concluded that little is known about the implementation of DSTs and possible negative ramifications of their use. Further, the cost to the VHA of noninvasive imaging testing, which has not been calculated, is needed to determine the cost of inappropriate tests.

OBJECTIVE(S):
For Specific Aim 1, we will assess potential barriers and facilitators to successful adoption of a DST. In Specific Aim 2, we will determine the effectiveness of a DST using a stepped implementation process. In Specific Aim 3, we will estimate the fiscal effectiveness of a DST in the VA health system by developing a micro-costing model for delivery of noninvasive imaging tests.

METHODS:
Based on the Practical Robust Implementation and Sustainability Model (PRISM) and Theoretical Domains Framework (TDF), this project examines the implementation of a DST and its effect on ordering of noninvasive imaging tests as follows: In Specific Aim 1, we will use qualitative methods to identify barriers and facilitators to DST implementation through interviews with physicians and other providers who order noninvasive tests. In Specific Aim 2, implementation of a DST for noninvasive imaging will be assessed from the rate of testing, the proportion of testing that is inappropriate, and feedback from providers on the use of the DST. In Specific Aim 3, the cost of noninvasive imaging tests will be calculated using information from administrative databases, time-and-motion observation of care delivery, and cost diaries from Veterans.

FINDINGS/RESULTS:
Not yet available.

IMPACT:
Thus far, data have provided insight as to how DST's might interfere with patient care. We have learned novel issues that may contribute to low value imaging. Further research will test concerns about DST's and estimate potential for avoided costs.

PUBLICATIONS:
None at this time.

DRA: Health Systems
DRE: TRL - Applied/Translational
Keywords: none
MeSH Terms: none