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

Shannon E. Ciprut; Matthew D. Kelly; Dawn Walter; Renee Hoffman; Daniel J. Becker; Stacy Loeb; Erica Sedlander; Craig T. Tenner; Scott E. Sherman; Steven B. Zeliadt; Danil V. Makarov

doi:10.1016/j.urology.2020.05.101

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

Shannon E. Ciprut, Matthew D. Kelly, Dawn Walter, Renee Hoffman, Daniel J. Becker, Stacy Loeb, Erica Sedlander, Craig T. Tenner, Scott E. Sherman, Steven B. Zeliadt, Danil V. Makarov

Public Health Research Center

Research output: Contribution to journal › Article › peer-review

Abstract

Objective: 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. Methods: 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. Results Fifty seven percent: (117/205) of Veterans before CROC installation and 73% (61/83) of Veterans post-intervention with low-risk prostate cancer received guideline-concordant care. Conclusion: 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.

Original language	English (US)
Pages (from-to)	113-119
Number of pages	7
Journal	Urology
Volume	145
DOIs	https://doi.org/10.1016/j.urology.2020.05.101
State	Published - Nov 2020

ASJC Scopus subject areas

Urology

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Ciprut, S. E., Kelly, M. D., Walter, D., Hoffman, R., Becker, D. J., Loeb, S., Sedlander, E., Tenner, C. T., Sherman, S. E., Zeliadt, S. B., & Makarov, D. V. (2020). A Clinical Reminder Order Check Intervention to Improve Guideline-concordant Imaging Practices for Men With Prostate Cancer: A Pilot Study. Urology, 145, 113-119. https://doi.org/10.1016/j.urology.2020.05.101

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

In: Urology, Vol. 145, 11.2020, p. 113-119.

Research output: Contribution to journal › Article › peer-review

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. / A Clinical Reminder Order Check Intervention to Improve Guideline-concordant Imaging Practices for Men With Prostate Cancer : A Pilot Study. In: Urology. 2020 ; Vol. 145. pp. 113-119.

@article{80e5f07340104f949afdae6b127496fa,

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

abstract = "Objective: 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. Methods: 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. Results Fifty seven percent: (117/205) of Veterans before CROC installation and 73% (61/83) of Veterans post-intervention with low-risk prostate cancer received guideline-concordant care. Conclusion: 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.",

author = "Ciprut, {Shannon E.} and Kelly, {Matthew D.} and Dawn Walter and Renee Hoffman and Becker, {Daniel J.} and Stacy Loeb and Erica Sedlander and Tenner, {Craig T.} and Sherman, {Scott E.} and Zeliadt, {Steven B.} and Makarov, {Danil V.}",

note = "Funding Information: Funding for this study was provided by the United States Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service ( VA IIR 15-356 ). This study is supported by The Prostate Cancer Foundation (PCF) , The John and Daria Barry Precision Oncology Center of Excellence of the VANYHHS , and The Edward Blank and Sharon Cosloy–Blank Family Foundation . Dr. Makarov is a Prostate Cancer Foundation Young Investigator awardee. The views expressed in this article are those of the author(s) and do not necessarily represent the views of the Department of Veteran Affairs. Publisher Copyright: {\textcopyright} 2020",

year = "2020",

month = nov,

doi = "10.1016/j.urology.2020.05.101",

language = "English (US)",

volume = "145",

pages = "113--119",

journal = "Urology",

issn = "0090-4295",

publisher = "Elsevier Inc.",

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T1 - A Clinical Reminder Order Check Intervention to Improve Guideline-concordant Imaging Practices for Men With Prostate Cancer

T2 - A Pilot Study

AU - Ciprut, Shannon E.

AU - Kelly, Matthew D.

AU - Walter, Dawn

AU - Hoffman, Renee

AU - Becker, Daniel J.

AU - Loeb, Stacy

AU - Sedlander, Erica

AU - Tenner, Craig T.

AU - Sherman, Scott E.

AU - Zeliadt, Steven B.

AU - Makarov, Danil V.

N1 - Funding Information: Funding for this study was provided by the United States Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service ( VA IIR 15-356 ). This study is supported by The Prostate Cancer Foundation (PCF) , The John and Daria Barry Precision Oncology Center of Excellence of the VANYHHS , and The Edward Blank and Sharon Cosloy–Blank Family Foundation . Dr. Makarov is a Prostate Cancer Foundation Young Investigator awardee. The views expressed in this article are those of the author(s) and do not necessarily represent the views of the Department of Veteran Affairs. Publisher Copyright: © 2020

PY - 2020/11

Y1 - 2020/11

N2 - Objective: 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. Methods: 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. Results Fifty seven percent: (117/205) of Veterans before CROC installation and 73% (61/83) of Veterans post-intervention with low-risk prostate cancer received guideline-concordant care. Conclusion: 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.

AB - Objective: 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. Methods: 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. Results Fifty seven percent: (117/205) of Veterans before CROC installation and 73% (61/83) of Veterans post-intervention with low-risk prostate cancer received guideline-concordant care. Conclusion: 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.

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

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